Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>The untethering of a tethered spinal cord in patients with a tight filum terminale is a relatively simple procedure that can prevent or improve neurological symptoms. Postoperatively, patients are usually kept in the horizontal decubitus position to prevent a CSF leak. However, the optimal period for keeping patients flat has not been determined yet. The authors compared 2 cohorts with different periods of horizontal decubitus; one with 72 hours and the other with 8 days.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors retrospectively analyzed surgical results in 2 cohorts of pediatric patients who had tethered spinal cord with a tight filum terminale. One cohort was maintained flat for 8 days and the other cohort for 72 hours postoperatively. The patients' charts were reviewed for demographic data, clinical presentation, surgical therapy, and clinical course.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Three hundred fifty-four patients underwent sectioning of a tight filum terminale. Of those, 238 were kept lying flat for 8 days postoperatively, and 116 were maintained flat for 72 hours. Magnetic resonance imaging was performed 1 to 2 weeks after the surgery. None of the patients in either cohort developed a CSF leak. Pseudomeningocele, which was confirmed by MRI, developed in 1 patient who had been kept flat for 8 days. The occurrence rates of a CSF leak and pseudomeningocele were not significantly different in either cohort.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Keeping patients flat for longer than 72 hours did not change the rate of postoperative CSF leakage or pseudomeningocele. Seventy-two hours or less would be an appropriate period for maintaining patients flat after transection of a tight filum terminale.</jats:p></jats:sec>

Outcome of hospital discharge on postoperative Day 1 following uncomplicated tethered spinal cord release

“…7 Both Chern and Ogiwara found that Post = postintervention; Pre = preintervention. * The p values are as follows: p = 0.02 (preintervention); p = 0.05 (postintervention); and p = 0.0021 (total group).…”

“…1 Recently, Ogiwara and colleagues 7 reported no CSF leaks in a large population of patients who were kept flat for 72 hours.…”

“…1,7 Because many patients have minimal or no symptoms at the time of operative detethering, the importance of complication avoidance in this population is paramount. There is little debate that a period of recumbency following tethered cord release probably lowers the risk of a CSF leak, but the optimal duration of this period is not well defined.…”

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

“…2,14,38 An untethering procedure may be associated with serious complications such as CSF leakage, CSF collection, wound dehiscence, and infection. 19,27,30,31 Despite a vast investigation of preventive interventions for such complications, 4,8,18,21,27 no evidenced-based guideline has yet been published.Although prophylactic administration of acetazolamide and/or bed rest following the intradural operation are acceptably used by both neurosurgeons and orthopedic surgeons, no high-level approved evidence exists regarding whether and how to use these measures.To the best of our knowledge, no randomized trial has assessed the prophylactic effect of acetazolamide in reducing complications following spinal surgeries. Likewise, abbreviations DS = dermal sinus; FF = fatty filum; LMMC = lipomyelomeningocele; SCM = slit cord malformation; TCS = tethered cord syndrome.…”

“…2,14,38 An untethering procedure may be associated with serious complications such as CSF leakage, CSF collection, wound dehiscence, and infection. 19,27,30,31 Despite a vast investigation of preventive interventions for such complications, 4,8,18,21,27 no evidenced-based guideline has yet been published.…”