1 level ACDF with complications - CSF leak (spinal fluid leak)
Hi! I'll try to be as brief as possible but I am looking for anyone who had a diagnosed CSF leak post cervical ACDF and can offer advice. Here's my synopsis: Had radiating pain and myleopathy in my left arm around 8/10/2013. Went to the emergency room and was diagnosed with herniated disc at c6/c7. Proscribed Medrol dose pac, narcotics and muscle relaxer. The steroids helped but pain returned when course completed. Saw three different spine surgeons who all recommended surgery. MRI showed large ruptured disc and osteophytes directly into the left side of c6/c7. Second medrol dose pack given, worked for 8 days but then pain returned. Was scheduled for ADR on 9/19 but insurance (BCBS of Mass) would not authorize procedure. I had been told by all three surgeons that the best chance of full recovery was to do the surgery as soon as possible - at this point I had been unable to lay down for more than a few minutes without severe discomfort in my left arm. Progressive weakness (left triceps reflex absent, starting to drop things, etc) had me moving forward with acdf instead. ACDF with hardware performed 9/27 at c6-c7. Immediate pain relief in arm post-op and able to lay flat for first time in 6 weeks with no arm discomfort. Yeah! sent home post op with instructions to not lift anything greater than 5 lbs. Soft neck collar given for comfort - but told not necessary. No other restrictions. (I think this surgeon is a lot less conservative than others - but said 1-level, young, healthy bones, non-smoker- not necessary). Had a very hard time swallowing for the first four days and was troubled with SEVERE headaches. I get headaches after taking opiates for a few days so by day three post op, so assumed that was the cause and switched to just Tylenol. I figured the headaches were just from the opiates - but they continued after switching to just tylenol. First post op appointment 1 week post surgery - headaches were better and steri-strips removed.
Doctor and I discussed symptoms and noticed that I had excessive swelling under my incision. He suspected CSF leak into the soft tissues and told me to watch for increased swelling, changes in voice or sever headaches but otherwise just come back in a week. Did not suggest bed rest and was hopeful that leak would seal itself on its own. I have a large lump (CSF Fistula?) under the incision. It appears to have gotten a bit larger, but that may just be because the other swelling in my neck has gone down and it's more readily seen. He did not want to drain it because the incision is healing very well and hoping to avoid the risk of infection. I still have headaches, but they are low grade. Occasionally have chills and dizziness and the spins.
Questions:
1. Has anyone else had a CSF leak, specifically in the cervical spine area?
2. What was the recommended treatment? In my research I've seen that bed rest is often recommended and am surprised that my doctor did not mention this.
3. If repaired, what was the method and how long did they wait to go in to do this?
Thanks very much for your help!
Karin
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C6/c7disc rupture
Recommended ADR by 2 docs
Scheduled for 1 level pro-disc replacement 9/18
Denied by insurance night before
Progressive myleopathy in left arm
Acdf performed 9/27/13
Possible csf leak/ seroma complication
Pain/myleopathy in left arm much improved!
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