Pilot study of perioperative accidental durotomy: does the period of postoperative bed rest reduce the incidence of complication?

Low, Jacob Chen Ming; Niederhäusern, Belinda von; Rutherford, Scott A.; King, Andrew T.

doi:10.3109/02688697.2013.798858

Cited by 42 publications

(21 citation statements)

References 13 publications

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“…In a retrospective analysis, Low et al 16 contended that there was no statistical signifi cance between the day of mobilization and the complication rate (low-pressure headaches, pseudomeningocele, and cerebrospinal fl uid leak) for patients with an incidental durotomy after lumbar spine surgery. In a retrospective analysis, Low et al 16 contended that there was no statistical signifi cance between the day of mobilization and the complication rate (low-pressure headaches, pseudomeningocele, and cerebrospinal fl uid leak) for patients with an incidental durotomy after lumbar spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Cost Analysis of Incidental Durotomy in Spine Surgery

Nandyala

Elboghdady

Marquez-Lara

et al. 2014

Spine

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Section: Discussionmentioning

confidence: 99%

Cost Analysis of Incidental Durotomy in Spine Surgery

Nandyala

Elboghdady

Marquez-Lara

et al. 2014

Spine

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“…Special consideration is required before performing a lumbar decompression at an ambulatory surgery center for a patient who is at high risk for a dural tear. Recent literature has suggested that there may not be a benefit to flat bed rest for more than twenty-four hours 52,53 . However, in clinical practice, many surgeons are still managing patients with flat bed rest for twenty-four hours or more, and such treatment may not be possible at an ambulatory surgery center.…”

Section: Lumbar Spine Surgery At An Ambulatory Surgery Centermentioning

confidence: 99%

Spine Surgery in an Ambulatory Setting: What Can Be Done Safely?

2015

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“…2,4,7,8,28 However, there is no consistency between surgeons on indication, duration, and position of the bed rest for prevention and management of CSF complications following lumbosacral spinal surgeries. 9,12,16,26,29,31 Experimental models of the dural reparative process showed that primary fibroblastic bridging of the durotomy appears at postoperative Day 6, and closure of the defect occurs at Day 10.…”

Section: Bed Restmentioning

confidence: 99%

Randomized clinical trial of acetazolamide administration and/or prone positioning in mitigating wound complications following untethering surgeries

Shahjouei

Hanaei

Habibi

et al. 2016

PED

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OBJECTIVE No evidence-based guideline has been approved for the postoperative management of pediatric patients with tethered cord syndrome (TCS). The purpose of this randomized clinical trial was to evaluate the effectiveness of prone positioning and acetazolamide administration on complication rates following spinal cord untethering surgeries. METHODS From October 2012 to February 2015, patients with a primary diagnosis of TCS who were admitted to the Children's Medical Center Hospital of Iran were randomly allocated to 1 of 4 intervention modality groups postoperatively: 1) Group A, acetazolamide administration for 10 days; 2) Group B, prone positioning for 10 days; 3) Group C, acetazolamide administration and prone positioning for 10 days; and 4) Group D, no intervention. CSF leakage, CSF collection, wound dehiscence, operative site infection, and secondary surgical wound repair were considered failure. RESULTS A total of 161 patients were enrolled in this study (Group A, n = 39 [24.2%]; Group B, n = 41 [25.5%]; Group C, n = 39 [24.2%]; and Group D, n = 42 [26.1%]). The overall failure rate was 12.42% (20 patients). Complication rates through pooled analyses were as follows: CSF leakage (n = 9, 5.6%), CSF collection (n = 12, 7.5%), wound dehiscence (n = 2, 1.2%), and infection of operation site (n = 3, 1.9%). Two patients (1.2%) required surgical secondary wound repair due to complications. CSF leakage and collection rates were significantly lower in patients who underwent prone positioning (p = 0.042 and 0.036, respectively). The administration of acetazolamide, either isolated or in combination with prone positioning, not only could not significantly lower the complication rates, but also added the burden of side effects. CONCLUSIONS The current study demonstrates the possible role of prone positioning in mitigating the complication rates subsequent to untethering surgeries. Clinical trial registration no.: NCT01867268 (clinicaltrials.gov)

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Pilot study of perioperative accidental durotomy: does the period of postoperative bed rest reduce the incidence of complication?

Abstract: A longer period of mandatory bed rest does not decrease the rate of complications. Patients should be mobilised as soon as they can. This could potentially reduce the length of hospital stay and the cost of aftercare.

Cited by 42 publications

References 13 publications

Cost Analysis of Incidental Durotomy in Spine Surgery

Cost Analysis of Incidental Durotomy in Spine Surgery

Spine Surgery in an Ambulatory Setting: What Can Be Done Safely?

Randomized clinical trial of acetazolamide administration and/or prone positioning in mitigating wound complications following untethering surgeries

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