J Korean Neurosurg Soc.  2021 Sep;64(5):799-807. 10.3340/jkns.2020.0350.

Reliability of Early Ambulation after Intradural Spine Surgery : Risk Factors and a Preventive Method for Cerebrospinal Fluid Leak Related Complications

• Lee S
• Cho DC
• Kim KT
• Lee YS
• Rhim SC
• Park JH

• KMID: 2519707
• DOI: http://doi.org/10.3340/jkns.2020.0350

Abstract

Objective
: Cerebrospinal fluid leakage related complications (CLC) occasionally occur after intradural spinal surgery. We sought to investigate the effectiveness of early ambulation after intradural spinal surgery and analyze the risk factors for CLC.
Methods
: For this retrospective cohort study, we enrolled 314 patients who underwent intradural spinal surgery at a single institution. The early group contained 79 patients who started ambulation after 1 day of bedrest without position restrictions, while the late group consisted of 235 patients who started ambulation after at least 3 days of bed rest and were limited to the prone position after surgery. In the early group, Prolene 6–0 was used as the dura suture material, while black silk 5–0 was used as the dura suture material in the late group.
Results
: The overall incidence rate of CLC was 10.8%. Significant differences between the early and late groups were identified in the rate of CLC (2.5% vs. 13.6%), surgical repair required (1.3% vs. 7.7%), and length of hospital stay (2.99 vs. 9.29 days) (p<0.05). Logistic regression analysis revealed that CLC was associated with practices specific to the late group (p=0.011) and the revision surgery (p=0.022).
Conclusion
: Using Prolene 6–0 as a dura suture material for intradural spinal surgery resulted in lower CLC rates compared to black silk 5–0 sutures despite a shorter bed rest period. Our findings revealed that suture - needle ratio related to dura defect was the most critical factor for CLC. One-day ambulation after primary dura closure using Prolene 6–0 sutures appears to be a cost-effective and safe strategy for intradural spinal surgery.

Keyword

Cerebrospinal fluid leak; Complications; Dural repair; Postoperative care; Spinal cord neoplasms

Figure

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  Fig. 1. Intraoperative microscopic image of dura closure performed using running locked suture technique. Prolene 6–0 suture was used for the early group patients (A); black silk 5–0 suture was used for the late group patients (B).

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  Fig. 2. Early group patients were discharged significantly faster (postoperative 2.99 days vs. 9.29 days, p<0.001), they started ambulation earlier after sit up (postoperative 1.06 days vs. 3.25 days, p<0.001). Despite the shorter duration of the early group’s hospital stay, the overall CLC rate was low. CLC : cerebrospinal fluid leakage related complications.

Reference

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