Early Epidural Cerebrospinal Fluid Leak After Anterior Cervical Discectomy and Fusion: A Case Report of Postoperative Intracranial Hypotension.

BACKGROUND Anterior cervical discectomy and fusion (ACDF) is a commonly performed and effective procedure for treating cervical spondylosis. Although cerebrospinal fluid (CSF) leakage is an uncommon complication, occurring in 0.2% to 1.7% of cases, it typically presents as an extraspinal leak. This report describes the case of a 51-year-old woman with postoperative headache due to an early epidural (intraspinal) CSF leak following ACDF - a complication that has not been previously reported. CASE REPORT A 51-year-old woman presented with chronic neck pain, cervicogenic headaches, and upper-limb paresthesia due to multilevel cervical spondylosis. MRI revealed discopathy at C4-C7. She underwent elective ACDF at C4-C7. During discectomy at C5/C6, a CSF leak was observed before exposure of the posterior longitudinal ligament (PLL) and was repaired intraoperatively using TachoSil, a muscle graft, and fibrin glue. On the first postoperative day, the patient developed headaches, nausea, and dizziness consistent with intracranial hypotension. MRI on postoperative day 4 revealed a ventral epidural CSF collection. Lumbar drainage was placed, resulting in resolution of symptoms and the CSF collection. Follow-up MRI at 6 weeks confirmed complete recovery. CONCLUSIONS This report presents a rare case of early epidural CSF leak following ACDF. Prompt recognition and conservative management with lumbar drainage resulted in full recovery without reoperation. Awareness of this potential complication can aid early diagnosis and prevent unnecessary surgical interventions.