The spine surgeon is often confronted with a draining operative wound and/or deep-lying fluid collection. The most frequently ascribed diagnoses are seroma, infection and cerebrospinal fluid (CSF) leakage. The diagnosis is determined by review of clinical data, the appearance of the wound, and laboratory tests such as white blood cell count, erythrocyte sedimentation rate, C-reactive protein and microbiology specimens. MRI can show fluid collection but does not necessarily differentiate between diagnoses. Often, a percutaneous needle aspiration is necessary for fluid analysis.
Beta-2-transferrin is a protein found only in CSF and perilymph. Meurman1 first described its use in the detection of CSF leakage in 1979. Since that time, beta-2-transferrin has been used extensively by otolaryngologists in the diagnosis of CSF rhinorrhoea and skull-base cerebrospinal fluid fistulas.