Prolonged Negative Suction Drainage for Managing Iatrogenic Anterior Cervical Dural Tears

Background: To evaluate outcomes, complications, drainage dynamics, and fusion integrity in patients with iatrogenic anterior cervical dural tears managed using prolonged negative suction drainage. Materials and Methods: A retrospective review of 1240 anterior cervical spine procedures (2004–2022) identified eight cases (0.65%) of intraoperative dural tears during anterior cervical discectomy and fusion ( n = 2) or anterior cervical corpectomy and fusion ( n = 6). Direct dural repair was unfeasible; oxidized cellulose was placed over the defect, and a subfascial Jackson–Pratt drain maintained at –100 mm Hg was used. Drains were removed when output was <20 mL/day for 2 days. Data included patient demographics, drainage characteristics, complications, and fusion status at 3, 6, and 12 months. Results: Mean age was 52.4 ± 8.1 years. Ossification of the posterior longitudinal ligament was present in four patients. Average drainage duration was 16.9 ± 3.1 days. Mean cerebrospinal fluid output was 85.6 ± 45.3 mL/day, peaking at 310 mL/day. Two patients with high initial output improved with acetazolamide and bed rest. Mobilization in bed was begun after 24 h and ambulation after 72 h. No infections occurred. Two patients experienced transient headaches. Solid fusion was achieved in all cases at 12 months. Conclusion: Prolonged negative suction drainage is a safe and effective strategy for managing anterior cervical dural tears when direct repair is not feasible, with minimal complications.