Cerebrospinal fluid leak after anterior cervical disc fusion: an unusual cause of dysphagia and neck mass

OBJECTIVE: Dysphagia after anterior cervical disc fusion (ACDF) is a common complaint. We present two cases of dysphagia caused by a rare complication after ACDF: cerebrospinal fluid (CSF) leak into the neck. STUDY DESIGN: A case series of two patients. METHODS: Both patients underwent a chart review, comprehensive history, physical examination, flexible nasolaryngoscopy, and radiographic imaging. A literature review of the MEDLINE database (1966-2006), using key words "dysphagia" and "anterior discectomy," was performed. RESULTS: We present two patients with persistent dysphagia after ACDF surgery caused by CSF leak into the neck. Their clinical presentation, physical and radiographic examination findings, and hospital course will be discussed. CONCLUSIONS: CSF collection presenting as dysphagia and neck mass after ACDF must be included in the differential diagnosis because incision and drainage is contraindicated, and fine needle aspiration (FNA) must be performed under sterile conditions. Treatment including lumbar drain or re-exploration is appropriate.