While the vast majority of surgeries are safe, undergoing any does mean you accept the risk of complications that your doctor has outlined. And with spinal surgery, cerebrospinal fluid leaks (also known as a CSF leak or a spinal fluid leak) is one such complication.
Anatomy of the Spine
Spinal surgery is delicate business, because you’re operating in and around the nervous system. One of the structures that is present, and particularly fragile, is the dura. This is a fibrous coating that surrounds the major nerves within the spinal canal, holding back spinal fluid. One of the more frequent complications is damage to this dura, resulting in a spinal fluid leak after back surgery.
Injuries to the dura, if not adequately repaired, can lead to a persistent leak of cerebrospinal fluid (CSF) out from where it belongs – this is because the spinal fluid is under greater pressure than the surrounding tissue. This kind of dural leak could impact the integrity of the nervous system, risking infection and causing meningitis.
CSF Leaks: How do they happen?
A range of different techniques can be used to repair a leak if found at the time of surgery, though many go unnoticed, and some even develop after the operation is complete. This is likely due to either thinning or damage to the dura at the time of the operation that was not noticed by the surgeon, or from a small spike of bone that was left against the dura that then causes a dural tear. Some do heal on their own, but if you notice fluid buildup after back surgery then it’s critical that you seek medical intervention to ensure proper healing.
How do you know you have a CSF Leak?
So, what are the spinal fluid leak symptoms that you should look out for post-surgery?
Well, one of the most common symptoms of a spinal fluid leak is having a headache with no head injury, that starts after the operation, which either occurs or is made worse by sitting and standing up. This happens because standing up increases the pressure in the lumbar region of the spine, allowing more fluid to come out into the soft tissue.
Other symptoms may include a new severe radiating pain down your leg or arm. This can happen when a portion of a nerve root is herniating through the tear, pinching the nerve.
Sometimes this nerve herniation, in addition to causing severe pain, may actually plug the hole, meaning the only symptom of the spinal fluid leak is this new pain.
Complications of untreated CSF leaks:
As mentioned, an untreated spinal/csf leak could result in an infection of the nervous system by any one of the number of bacteria that can be found on the skin or in the environment. But it’s important to realize that if not treated properly, this can lead to permanent disability or death.
Even if the spinal fluid does not leak all the way out through the skin, it could lead to reflux of spinal fluid from the nervous system back and forth into the spinal cavity and in doing so, bringing dangerous bacterias and bodily byproducts into the nervous system. When the nervous system then deposits these items on the surface of the brain and spinal cord, it can lead to disabling neurologic symptoms. These can range from headaches to severe nerve dysfunction in a condition known as superficial siderosis.
How do you fix a CSF Leak?
There’s a variety of techniques that a surgeon can use to repair a spinal fluid leak, and of course, they all have different success rates, but it’s crucial that you seek medical attention – this is not a condition that bed rest will fix. Which technique is used will depend on the severity of your fluid build up, and the duration.
Some CSF leaks may require up to even three operations to fix, while others may take the first time; each leak is different and unique, just like our patients. While all spine surgeons (orthopedic and neurosurgery) are taught basic skills and how to repair dural defects and injuries, neurosurgeons have specialized training in these particular types of surgical procedures.
Anything we operate around we put at hypothetical risk of being injured in one way or another. This is true regardless of what type of surgery is being performed and whether it is minimally invasive or maximally invasive.
In general, a patient should always ensure that their surgeon, if operating around the nervous system, has the skills necessary not only to do the procedure that they are describing, but to manage any potential complications that might arise.
While CSF leaks rarely lead to severe or dire consequences if found at the time of the operation, untreated spinal leaks can absolutely be fatal. Spinal surgery is not to be undertaken by or on the weak of heart; having said that, the vast majority of patients have no complications, and proper monitoring both by the doctor’s office and the patient after surgery is crucial.