Spine fusion cross-link causing delayed dural erosion and CSF leak: case report

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedic Surgery

Background:

• Lumbar spinal fusion surgery has increased significantly over the past two decades.
• Cross-links are used in pedicle screw-rod constructs to enhance spinal stabilization and resistance to stress.
• These devices aim to improve fusion outcomes and construct rigidity.

Observation:

• A 49-year-old woman presented 11 years after L4-5 spinal fusion with a pedicle screw-rod construct including a cross-link.
• She developed severe symptoms including postural headaches, neurogenic claudication, and radiculopathy.
• Imaging showed spinal canal compression and a possible thickened filum terminale at the instrumented level.

Findings:

• Reexploration revealed a large erosive dural defect with a cerebrospinal fluid (CSF) leak.
• The cross-link was associated with spinal canal compression and a thickened filum terminale.
• This represents a rare, previously unreported complication of spinal fusion with cross-links.

Implications:

• This case highlights a rare complication associated with the use of cross-links in spinal fusion.
• It underscores the critical need to avoid dural compression when implanting spinal fusion hardware.
• Surgeons should be vigilant for delayed complications related to spinal instrumentation, even years post-surgery.