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Final Program


Final Program

1239 - Identification and Management of a Cerebrospinal Fluid Fistula Wound Complication in a 17-Year-Old Spinal Cord Injury Patient: A Case Report

Friday, February 28, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • KH

    Kaitlyn Hansen, MD

    PM&R PGY2 Resident
    Corewell Health East Taylor
    Taylor, Michigan, United States

    • Co-Author(s)

  • JB

    James Borges, MD

    PM&R PGY2 Resident
    Corewell Health East Taylor
    Taylor, Michigan, United States

  • OH

    Omar Hashwi, MD

    Medical Student
    St. George's University School of Medicine
    Taylor, Michigan, United States

  • RS

    Riley Smith, MD

    TBI PM&R Faculty
    Corewell Health East Taylor
    Taylor, Michigan, United States

  • TR

    Tyler Roskos, PhD

    Clinical Neuropsychology Faculty and Director of Reserach
    Corewell Health East Taylor
    Taylor, Michigan, United States

Case Diagnosis:

17-year-old female found with cerebrospinal fluid (CSF) fistula formation secondary to gunshot wound (GSW) resulting in complete spinal cord injury.


Case Description:

A 17-year-old female presented for rehabilitation after a GSW to her thoracic spine resulting in T10 complete spinal cord injury (SCI). She suffered from T12-L3 comminuted fractures. It was managed nonoperatively due to the nature of the injury and small bullet fragments located within the abdomen and the wound was kept open. During her rehab stay the patient had copious clear fluid draining from her wound. There was no halo sign present on the dressing. Ultrasound found a hypoechoic area, likely hematoma or phlegmon. There was suspicion of infection so IV antibiotics were started. Beta2 transferrin tested positive and she was taken for debridement and primary closure. During surgery a fistula was found arising from the thecal sac to the skin. The fistula was excised, wound debridement and primary closure were performed.


Discussions: Wound complications after a high impact spinal cord injury can include infection, fistula formation, seroma or hematoma. It’s been recorded that fistula formation can occur in about 9% of all penetrating SCI. It can appear as any leak onto the skin, into subcutaneous tissues or within internal parts of the body. A fistula formation after GSW to the spine poses a serious risk of meningitis. Quick identification and treatment can prevent serious harm to patients.

Conclusions: CSF leaking fistula formation in GSW spinal cord injury patients is a rare complication but poses serious health risks. With the use of further imaging and lab monitoring it can more easily be identified. Initiating prophylactic antibiotics is important to lessen the chance of meningitis. Having a multidisciplinary team for treatment of wound complications in SCI patients is important for patient rehabilitation.