A spinal fluid leak, also known technically as a CSF leak or intracranial hypotension condition, can occur for many reasons and affects many back pain patients who choose surgical interventions as part of their treatment process. Cerebral spinal fluid is the protective liquid which is encased in the dura and surrounds the brain and spinal cord. When the fluid leaks, it can create symptomatic conditions that range from minor to extreme.
Few patients realize that any procedure which punctures the protective membrane around the spinal structures has a fair chance of causing a fluid leak. Few patients also realize the consequences of continuing fluid leaks or the fact that secondary reparative surgery is often needed.
This article focuses on CSF leaks which occur due to back surgery and epidural injection therapy treatments, as well as back injuries. Other forms of spontaneous fluid leaks may occur idiopathically or due to disease processes.
What is a Cerebral Spinal Fluid Leak?
A CSF leak is diagnosed when a patient suffers a hole or rip in the dura membrane which retains the spinal fluid around the central nervous system components. The dura is a tough structure, but is often damaged during invasive medical treatments for chronic back pain.
The brain actually floats in CSF, cushioning and insulating it against all types of harm. When a leak occurs, the bottom of the brain can sink downwards into the skull, compressing sensitive neurological tissues in the process. CSF is produced in the brain at a fast pace. In a normal adult, the amount of CSF produced in a day will be 2.5 to 3 times the total membrane capacity; with excess constantly draining into the venous structures as new fluid is produced. When a significant leak occurs, the volume produced may not be enough to compensate for the amount lost into the body cavity, resulting is potentially serious symptoms.
Spinal Fluid Leak Symptoms
The usual symptoms of CFS leaks, regardless of the cause, include any or all of the following:
Severe headache is virtually universal in all patients, and is often worse when the body is upright and relieved when reclining.
Dizziness, vertigo and/or nausea are common related symptoms.
Numbness or weakness in the facial muscles can occur in some patients with severe fluid loss.
Strange neurological sensations or sensory impairments, including possible symptoms in the ears, eyes, mouth or nose are incredibly prevalent in many types of intracranial hypotension conditions.
In rare cases, severe brain ischemia leading to spinal stroke or even death might occur.
CSF Leaks and Invasive Treatment
The most common causes of CSF leaks in back pain sufferers include side effects of both epidural injections or back surgery procedures.
Epidurals puncture the dura in order to deliver their pain medication to the designated target. In most cases, this puncture heals very fast and causes no ongoing issues. In some patients, the pinhole may not heal and in others, the doctor actually tears the dura sac inserting or removing the needle, leading to a severe leak scenario. I know of many patients who have endured chronic leaks from various back pain injection therapies.
The most common source of significant leaks of cerebral spinal fluid is certainly spinal surgery. When the spine is the subject of an invasive procedure, regardless of how minimally invasive it may be, CFS leaks are commonplace. Most will resolve without treatment or with minor professional interventions, but some require secondary surgeries to correct. This is the last hassle a back pain sufferer needs after undergoing the often horrific reality of a spinal operation.
