Sternocleidomastoid muscular flap: treatment of persistent cerebrospinal fluid leak after anterior cervical spine surgery.

STUDY

DESIGN

Retrospective review.

OBJECTIVE

To describe a novel application of rotational sternocleidomastoid (SCM) muscle flap in management of ventral cervical durotomy.

SUMMARY OF BACKGROUND DATA: Even for the most experienced surgeons, incidental durotomy is a common occurrence in spine surgery. Primary direct suture repair is indicated to avoid possible complications such as pseudomeningocele or spinocutaneous fistula formation. Significant secondary effects of these complications have been described, including airway compromise, radiculopathy, myelopathy, and infection. When primary repair is not feasible, surgeons have used alternative management techniques based on their clinical judgment. In the setting of persistent symptomatic cerebrospinal fluid leak after repair, reoperation is warranted.

METHODS

A retrospective review was conducted of clinical records and radiographic data for 2 patients who underwent reoperation for management of ventral cervical durotomy encountered during anterior cervical spine surgery. SCM muscular flap was used to augment durotomy repair.

RESULTS

Both patients did not have any persistent cerebrospinal fluid leak after repair with pedicled SCM muscle flap, and did not require any further surgical procedures related to the cervical spine.

CONCLUSIONS

The use of a rotational SCM muscular flap may be useful in cases of ventral cervical durotomy refractory to conventional management.