Delayed symptoms of cerebrospinal fluid leak following lumbar decompression

Numerous reports in the literature describe cerebrospinal fluid (CSF) leaks resulting from dural tears; however, most of these reports document symptoms of incidental durotomy occurring ,48 hours postoperatively. This case report describes patients with symptoms of CSF leak occurring a few days to a few weeks after lumbar spine surgery who required additional surgery to repair the dura and alleviate their symptoms. Records for patients who had lumbar spine surgery performed by 2 spine surgeons at a single institution between 1990 and 2005 were reviewed. After additional surgery to repair what appeared to be late postoperative durotomies, 2 patients recovered fully from their orthostatic headaches and reported satisfactory relief of their preoperative neurological symptoms. They did not have symptoms of spinal fluid leakage following surgery, and no intraoperative dural tear was noted, suggesting these cases may have been secondary to late postoperative durotomy. The incidence of durotomy has been noted to be increased in patients undergoing revision spine surgery secondary to adhesions and scarring of the dura. As this was the first spine operation for both cases reported, we believe that residual bone spikes are responsible for puncturing the dural sac postoperatively. Spine surgeons should be exceedingly cautious in inspecting for bone spikes following an extensive dural exposure and recognize the significance of the new onset of an orthostatic headache, even days or weeks following spine surgery.