En bloc spondylectomy is a complex spinal procedure that is indicated for the management of primary bone tumors of the spine. It is a high-risk procedure, with cerebrospinal fluid (CSF) leak being one of the most common complications. In this study, the authors reviewed risk factors for CSF leak during en bloc spondylectomy. Their postoperative CSF leak rate was 23.6%, but 76% of these patients did not require reoperation. Of interest, all four patients who required reoperation had a history of surgical site irradiation.
This is an important study that highlights several important concepts in the surgical management of spinal tumors. First, CSF leak is a common, but generally benign complication in these extensive surgical procedures. The patient should be counseled appropriately on this risk and the potential postoperative management strategies for CSF leaks, including need for reoperation. Second, irradiation is a significant risk factor for tissue scarring, and hence, the occurrence of CSF leak. Therefore, in many instances, it is safer to proceed with surgical resection before adjuvant therapy, when indicated. The risk of CSF leak, wound infection and delayed healing are all increased in patients who have had irradiation before surgery. The multidisciplinary team evaluating these patients should consider this.
In summary, this work addresses an important intraoperative complication of en bloc spondylectomy. Proper diagnosis, management and patient counseling is essential in these highly specialized surgical procedures
Ali A. Baaj, MD
Assistant Professor of Neurosurgery
Adult and Pediatric Spine Surgery
Weill Cornell Medical College
New York Presbyterian Hospital
New York City
Disclosures: Baaj reports no relevant financial disclosures.