Spinal Fluid Leak

I am sure many of you in the Northwest have seen the news articles relating to Steve Kerr, coach of the Golden State Warriors, who had recently undergone a procedure to repair his cerebrospinal fluid leak. This occurred nearly 2 years following his back surgery. Many of the newspaper articles described his experience with debilitating back pain and headaches.  I have had many friends and family ask me what caused this so I thought I would pass on my explanation. 

First, let us start with anatomy, cerebrospinal fluid (CSF) is a clear liquid that surrounds the brain and spinal cord providing a cushion as well as nutrients and immunological protection.  The fluid is held in place by a lining called dura.  When there is a tear in the dura and CSF leaks out, there is a decrease in fluid and pressure. This decrease can lead to severe headaches that often resolve with lying flat.  A spontaneous leak is very rare.  This is most often caused by trauma or a history of intervention that leaded to puncturing of the protective coating to obtain fluid. An additional way this can happen is from previous scar tissue buildup that adheres to the dura.  With scar tissue formation this can later be torn with significant activity this can pull causing a tear. 

Coach Kerr suffered from a tear following a lumbar surgery. One article quotes Steve saying that back surgery should always be avoided.  I agree with this to some extent.  Rehabilitation and every method of conservative treatment should be attempted before undergoing any surgery.  The side effect that Steve experienced is extremely rare and should not be used to guide medical decision making.  This was one person’s unfortunate experience.  The Orthopaedics & Traumaology: Surgery & Research reports that the chance of a dural tear for lumbar surgery is less than 2%.  Most often dural tears occur during the surgery itself when scar tissue, bone, or disc material has actually adhered to the dural and when corrective surgery is performed.  This tear is then sutured and possibly “patched” with a special material to stop the leak of fluid. 

It is important to know the risks and benefits prior to undergoing any medical procedure or surgery.  There are even significant side effects for some people for something as simple as allergy medication like Benadryl.  It is important that each patient is aware of these possible side effects and notify their provider if they believe the medication may be causing new symptoms. 

Many of my patient’s come in with stories of someone that they know or are acquainted with that had a bad experience. However, as medical providers our job is determine each patient as an individual and what their choices are.  There is not one answer or treatment that will work for every spine patient.  This is why it is important to meet your surgeon and care team and come to a decision together and for the patient to feel comfortable with the decision prior to moving forward with any treatment including surgery.

If you are interested in more information on how to pick a surgeon for you, please see the previous blog from 5/27/16 written by Dr. Sales.

Shaylan Zanecki PA-C
Director of Patient Safety & Clinical Research  ​