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CSF Leak and Cauda Equina Syndrome

If you suffered a CSF leak during lumbar surgery and this caused you to develop cauda equina compression, please get in touch with us to discuss your options.

What is a CSF leak?

‘CSF’ stands for cerebrospinal fluid. Cerebrospinal fluid is a clear coloured liquid that can be found in the brain and spine. It has a number of functions, including:

A CSF leak is when the cerebrospinal fluid leaks out into the dura, which is the protective layer that surrounds the brain and spinal cord. This leak can happen for no apparent reason. However, it can also happen during a medical procedure such as a lumbar puncture or lumbar surgery.

CSF leak during lumbar surgery

If back surgery is complicated by a CSF leak, it will need the placement of a fat graft and a blood clot inducing agent such as Surgicel. However, if a patient wakes from the general anaesthetic and goes on to wet the bed, and needs a urinary catheter on the ward, alarm bells should start ringing.

Indeed, these symptoms may be considered indicative of urinary problems and in the context of lumbar spinal surgery, cauda equina compression should be contemplated. Subsequently a neurological examination should take place and an urgent MRI scan performed.

How does a CSF leak cause cauda equina compression?

A CSF leak can result in cauda equina compression in a number of ways. For example, the fat grafts can distort the thecal sac at the L4/5 level, which is where the cauda equina nerves lie. Or there may be a collection of fluid deep inside the fat grafts that comes into direct contact with the thecal sac, which in turn causes compression. The fluid can be made up of CSF and blood products. Surgicel may also be mixed in with this fluid, although this is usually very difficult to identify on imaging tests.

There are also other ways in which the cauda equina nerves become damaged. For instance, the compression can be caused by a post-operative haematoma. Or there may have been a nerve injury at the time of surgery. With a CSF leak it is possible for a nerve root to herniate out through the defect in the thecal sac and cause nerve root damage.

Speak to a solicitor

If a patient’s symptoms are not recognised as cauda equina syndrome, it will mean that a second operation to reverse the damage will be delayed. This could cause the patient to suffer irreparable harm. If this has happened to you, please get in touch with us to speak to a solicitor. You could be entitled to compensation.

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