Do Dural Sealants Reduce Csf-related Complications Following Intrathecal Pump Placement?

Introduction: The latest generation of catheters for Intrathecal Drug Therapy have been associated with a rate of CSF leak between 20-30%. This leak may manifest as postural headache, incisional drainage, seroma and/or pseudomeningocele. In other spine surgeries with high likelihood of leaks, dural substitutes may be used. We compare our rates of CSF-related complications before and after instituting this complication mitigation strategy (e.g. use of both sealant and dural substitute).

Methods: We examined all patients who had received a pump at our institution over a one-year period and compared 30-day CSF related complications.

Results: Seventeen control patients were compared to 8 patients who underwent the augmented closure technique. The control group had 1/17 complications and the dural sealant group had 3/8 complications (p = 0.08). There was one CSF leak in each group (p = 0.55), and one postural headache and one seroma in the sealant group. Notably in the one CSF leak that occurred in the dural sealant group, the suture burying the nose of the anchor within the fascia had failed.

Conclusion: Intrathecal drug therapy provides meaningful pain relief to many patients. CSF egress can add to the morbidity of the procedure and may lead to pseudomeningocele, infections and other complications.