SynthesisJournal of orthopaedic surgery and research2025
Diagnosis and treatment of subarachnoid-pleural fistula following thoracic spine surgery: a case series study and systematic literature review.
Synthesis in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveSubarachnoid pleural fistula (SPF) is a rare and intractable condition when the dura and parietal pleura tear occur simultaneously. This study aims to report the clinical outcomes of conservative treatment for SPF and make a systematic literature review of the diagnosis and treatment of SPF.
methodsBetween November 2015 and December 2024, the records of patients diagnosed as SPF following thoracic spinal surgery were investigated. All the medical records including demographic information, laboratory tests, radiological examination, treatment modalities and clinical outcomes were reviewed.
resultThe overall incidence of SPF following thoracic spinal surgery was 6.7% (9/135). All the 9 patients had undergone posterior thoracic three column osteotomy. Persistent pleural effusion was the most common characteristic. Additionally, patients presented symptoms such as chest distress, expiratory dyspnoea, and postural headache. Persistent pleural effusion could be detected on chest X-rays, ultrasound, and computed tomography scans. Magnetic resonance imaging could detect the communication between epidural and pleural effusion. All patients were treated conservatively by either or combination of bed rest, noninvasive positive pressure ventilation (NPPV), lumbar cistern drainage, and closed thoracic drainage. All the patients healed well without exploratory repair of spinal dura or pleura until the average follow-up time of 31.6 months.
conclusionsAfter thoracic spinal surgery involving parietal pleura manipulation and cerebrospinal fluid leakage, SPF should be suspected with abnormal pleural effusion. Although surgical repair is most commonly used in previous studies, we found SPF could be healed by conservative treatment including bed rest, pleural drainage, lumbar drainage and NPPV.
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