Case of Yellow-tinged CSF?

[ethilo]

Hey guys,
66M prior uncomplicated L3-4 spinal fusion with 4 level laminectomy 8 months ago now came in for THA. I offered spinal vs GA with emphasis that he has a higher chance of spinal failure and conversion to GA anyway, he agrees to try spinal.

We get into the spinal, I went midline, sitting patient, likely L2-3 ish and got CSF on 1st needle pass with a 25G whitacre, no redirections or anything. He had a brief blood tinge but after that cleared he had persisting yellow CSF. Like, obviously completely yellow, beyond contamination from the needle pass. It also seemed to be under higher pressure than I otherwise would feel from free-flowing CSF. with injecting I could actually see the CSF leaking out around the needle from the introducer needle. Patient reported zero effects from the spinal and we switched to GA.

Not sure how to interpret this, I was reading xanthochromia can be from inflammation and blood present in CSF. This was different from the usual little bit of blood from a needle pass. Anyone have any insights? I'm guessing I wasn't intrathecal because he had no change from the injection, but it really was classic appearing CSF flow and feel beyond 1) higher pressure and 2) yellow-tinged.

---

Members don't see this ad.

 

[DocVapor]

Urine?


Edit:. Sorry, I had to.

 

[DrAmir0078]

Urine?


Edit:. Sorry, I had to.

I would send it to the lab if that possible !
But what to label it? CSF or Urine or just body fluid?

 

[deleted697127]

Hey guys,
66M prior uncomplicated L3-4 spinal fusion with 4 level laminectomy 8 months ago now came in for THA. I offered spinal vs GA with emphasis that he has a higher chance of spinal failure and conversion to GA anyway, he agrees to try spinal.

We get into the spinal, I went midline, sitting patient, likely L2-3 ish and got CSF on 1st needle pass with a 25G whitacre, no redirections or anything. He had a brief blood tinge but after that cleared he had persisting yellow CSF. Like, obviously completely yellow, beyond contamination from the needle pass. It also seemed to be under higher pressure than I otherwise would feel from free-flowing CSF. with injecting I could actually see the CSF leaking out around the needle from the introducer needle. Patient reported zero effects from the spinal and we switched to GA.

Not sure how to interpret this, I was reading xanthochromia can be from inflammation and blood present in CSF. This was different from the usual little bit of blood from a needle pass. Anyone have any insights? I'm guessing I wasn't intrathecal because he had no change from the injection, but it really was classic appearing CSF flow and feel beyond 1) higher pressure and 2) yellow-tinged.

I wouldn’t stick a needle near new hardware. You think if that hardware gets infected the surgeons going to care if you went at a different level?

For labor and delivery, I would but not for a joint without a very good justification.

 

[Timeoutofmind]

Prob a seroma
common in post op spines

 

[abolt18]

Seroma is my biggest guess.

 

[Beach bum]

Agree with seroma especially since spinal didn’t work.

 

[GassYous]

Marrow

 

[PainDrain]

First guess would be seroma. Second would be urine.

 

[OB1🤙]

Could also be a facet cyst.

A strange but true phenomenon. Have seen it firsthand.

 

[deleted875186]

4 level lami and fusion…. I wouldn’t have attempted the spinal just so that in 5 years when he has terrible axial back pain and degeneration and stenosis at the level above his fusion, he doesn’t blame it on the small 25G spinal needle attempt.

Agree with seroma. Level probably doesn’t matter in this case, surgeon has ideally taken out the spinous processes and shaved off lamina making it easier. I probably would have pulled out and tried another level.

 

[Velefunt]

Spinal/Synovial cyst vs seroma.

 

[PainDrain]

Another possibility is a tarlov cyst but unlikely if it was still present after a surgery.

 

[NJPAIN]

Almost 100% seroma. They can persist for years in the area of posterior spinal surgery.