How serious is a CSF leak after spine surgery?

Question

Hello doctor,

My wife went for a routine MRI of the spine and found a lesion 14 x 12 mm, intraspinal, intradural focal lesion opposite L2 vertebral body with intense post-contrast enhancement suggestive of a neurogenic tumor. Doctors advised surgery, so we had surgery last week. After surgery, all her mobility was good, but the doctor suspected a CSF leak and installed epidural drainage, and advised 48 hours no movement bed rest.

The drain was a lot the first two days, around 5.07 - 6.76 fl. oz per day, but my wife's overall condition was good. I think out of concern for the amount of drain. The doctor prescribed Diamox 1000 mg per day. After that, the drain starts to produce 0.3 - 0.6 fl oz per day. My wife has massive headaches all day long, even with painkillers (Paracetamol, Ketorolac, and Tramadol).

We try to visit the bathroom two times a day for two minutes, but she gets super dizzy and has massive headaches. We have to put her to bed immediately. It has been six days since the surgery without any improvements. Is the doctor's plan correct? Should we wait on Diamox until the wound heals and the drain stops?

Can I blame the doctor for failure to close the dura and put us through all these sufferings? When can we stop Diamox or remove the drainage? How serious is my wife's case now? Is this normal, or shall I worry? How long will it take for the headaches to go away? And when will she be able to stand without feeling heavy in the head and dizziness?

Please guide.

Answer 1

Hello,

Welcome to icliniq.com.

This is the usual plan in such cases. A headache is due to a leak of CSF (cerebrospinal fluid), causing low pressure in the head. The leak of CSF (cerebrospinal fluid) is a well-known risk factor associated with any intradural spinal surgery, so the doctor is not at fault. Once there is adequate time given to heal. The doctor will suggest when to remove it. There is no exact time when it will be removed.

There is nothing serious. Do not worry at all. The only thing you need to take care of is to keep the drainage site untouched and unsoiled, as it can cause infection. The headache will reduce once the drain is out. Before getting out of bed, clamp or close the drainage tube for just a while and then open it immediately after returning to bed. This can prevent severe headaches.

I hope this helps you.

Thank you.