Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Anterior decompression is an effective way to treat cervical myelopathy associated with ossification of the posterior longitudinal ligament (OPLL); however, this approach is associated with an increased risk of a dural tear and resultant CSF leak because fusion of the dura with the ossified PLL is common in these cases. The authors review the literature and present an algorithm for treatment of CSF leaks in these patients.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A MEDLINE review was performed to identify papers related to CSF leak after anterior decompression for OPLL, and data were summarized to identify treatment options for various situations. A treatment algorithm was identified based on these findings and the experience of the authors.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Eleven studies were identified that presented data on intra- and postoperative management of a CSF leak during ventral surgery for OPLL. The incidence of cervical dural tears and CSF leaks after anterior decompression procedures for OPLL ranged from 4.3% to 32%. Techniques including preventative measures, intraoperative dural repair with various materials, and postoperative drainage or shunt placement have all been used.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Although direct dural repair is the preferred treatment for CSF leak, this technique is not always technically possible. In these cases, intraoperative adjuncts in combination with postoperative measures can be used to decrease the pressure gradient across the dural tear.</jats:p></jats:sec>

Ossification of the Posterior Longitudinal Ligament: A Review of Literature

“…When the pathologic focus is localized below the 3rd-4th cervical vertebrae, a direct anterior approach to the pathology can lead to a good result, but the risk of spinal cord injury is high and in the case that OPLL is not separated from the dura mater, there is a risk of developing complications such as a dural tear or CSF leakage [31,32]. …”

Acute spontaneous cervical disc herniation causing rapidly progressive myelopathy in a patient with comorbid ossified posterior longitudinal ligament: Case report and literature review

“…The incidence of CSF leakage in the anterior approach has been estimated to range from 4.3% to 32%. [15] In the present case, the rapidly progressive nature of the myelopathy motivated an anterior surgical approach; whereas slow onset, progressive symptoms in the context of OPLL would motivate long-segment posterior decompression and fusion.…”

“…[15] While observation of asymptomatic OPLL remains the standard of care, symptomatic canal stenosis caused by OPLL can require surgery. [22] Anterior decompression of the ventrally located pathology is often indicated and has shown lower rates of symptom recurrence, but higher rates of postoperative complications.…”

A novel technique to correct kyphosis in cervical myelopathy due to continuous-type ossification of the posterior longitudinal ligament

“…1,9 These complications included the risk of a dural tear or CSF leakage, which was difficult to repair in anterior cervical surgery. 2,13 The incidence of dural tear and CSF leakage has been reported to be 13.7-fold greater in patients with OPLL compared with patients affected by other conditions. 8 It has also been reported that CSF leakage frequently occurs when a double-layer sign can be identified by a CT scan, which also occurred in our cases (Fig.…”