Leakage of cerebrospinal fluid and secondary intracranial infection induced by Cloward technique of cervical discectomy and fusion: presentation and treatment

Abstract

Cloward technique of cervical discectomy and fusion is a long and complex surgical procedure and instrumentation, by which complicated infection is rare in an era of routine prophylactic antimicrobial agent, especially in procedures by anterior approach. A study in the journal of Spine suggested that the incidence of unintentional laceration of the dura mater during spinal surgery might be as high as 14%.1 A majority of them are repaired intraoperatively and/or present as a spontaneous process of healing. Therefore, leakage of cerebrospinal fluid (CSF) and secondary intracranial infection induced by incidental durotomy are rare. Levi et al.2 reviewed spinal instrumentation procedures in 452 cases at a single institution, finding that 17 patients got infections in the operative areas. Infection occurred after posterior spinal instrumentation procedures (7.2%) and no infection was found after anterior instrumentation procedures regardless of the vertebral levels. Likewise, Aydinli et al.3 reported that 8 patients were complicated by acute infection out of 174 patients undergoing instrumented spinal surgery, including no anterior procedures. To our knowledge, we are the first to report a complete clinical course concerning CSF leakage and secondary intracranial infection induced by Cloward technique of cervical discectomy and fusion.