Management of cerebrospinal fluid leakage complicating anterior procedures through thoracotomy: report of three cases.

Postoperative cerebrospinal fluid (CSF) leakage is a serious complication accompanying an anterior procedure through thoracotomy, and it is difficult to cure. In this report, we present three patients with CSF leakage in the thoracic spine complicating anterior decompression and fusion for ossification of posterior longitudinal ligament who were treated by surgical or nonsurgical methods. As a surgical method, direct closure by fixing substitute dura mater with fibrin adhesive sealant or cyanoacrylate adhesive was performed in two patients. This technique was effective but required another thoracotomy. As a nonsurgical method, intrapleural administration of OK-432 through chest drainage tubes was also effective to reduce intrapleural effusions in one patient, but with this method, care must be taken for neurotoxic reactions. Both techniques seem to be useful and effective for postoperative intrapleural CSF leakages complicating anterior procedures through thoracotomy.

Cervical disc herniation causing localized ipsilateral popliteal pain.

We report a patient with localized ipsilateral popliteal pain that we believe was caused by cervical disc herniation. A 52-year-old woman complained of an unusual severe aching pain in the right popliteal region. The pain increased gradually for 4 months despite the employment of conservative treatments. Eventually, the woman was unable even to stand immediately after waking because of the pain. However, physical examination of the right knee joint showed little abnormality. Although radiography of the knee joint showed slight osteoarthritic change, the pain remained unexplained. The patient also reported shoulder stiffness and slight numbness in the bilateral toes. Magnetic resonance imaging showed a large disc herniation on the right side of C3/4 and narrowing of the spinal canal at C4/5. Anterior cervical decompression and fusion surgery (C3-5) was performed to prevent impending myelopathy. After surgery the popliteal pain disappeared immediately and completely, suggesting that the cervical disc herniation had caused the pain. The pain has not recurred in almost 3 years after surgery.