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24.09.2019 | Original Article

No benefit of early versus late ambulation after incidental durotomy in lumbar spine surgery: a randomized controlled trial

Zeitschrift:
European Spine Journal
Autoren:
Mazda Farshad, Alexander Aichmair, Florian Wanivenhaus, Michael Betz, Jose Spirig, David Ephraim Bauer
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00586-019-06144-5) contains supplementary material, which is available to authorized users.

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Abstract

Purpose

Incidental durotomy (ID) is a complication occurring in 4–17% of decompressive spinal surgeries. Persisting CSF leakage can occur even after ID repair and requires revision surgery. Prolonged flat bed rest (BR) to reduce the incidence of persisting CSF leakage is frequently applied but highly debated. A randomized controlled trial comparing prolonged BR versus early ambulation after ID repair is lacking. The aim of this study was to investigate the incidence of revision surgery as a result of persistent cerebro-spinal fluid (CSF) leakage and medical complications after immediate or late post-operative ambulation following ID during decompressive spinal surgery.

Methods

Ninety-four of 1429 consecutive cases undergoing lumbar spine surgery (6.58%) were complicated by an ID. Sixty patients (mean age of 64 ± 13.28 years) were randomized to either early post-operative ambulation (EA, n = 30) or flat BR for 48 h (BR, n = 30). The incidence of CSF leakage resulting in revision surgery, medical complications and duration of hospitalization were compared between groups.

Results

Two patients in the BR group and two patients in the EA group underwent revision surgery as a result of persisting CSF leakage. Four patients in the BR group experienced medical complications associated with prolonged immobilization. The duration of hospitalization was 7.25 ± 3.0 days in the BR group versus 6.56 ± 2.64 days in the EA group, p = 0.413.

Conclusion

The results of this study indicate no benefit of prolonged BR after an adequately repaired ID in lumbar spine surgery.

Level of evidence

Level 1b (individual randomized controlled trial).

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

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Zusatzmaterial
Supplementary file1 (PPTX 157 kb)
586_2019_6144_MOESM1_ESM.pptx
Literatur
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