Spine

摘要

No benefit of early versus late ambulation after incidental durotomy in lumbar spine surgery Incidental durotomy is common during elective spine surgery, with the incidence quoted as reaching up to 17% in some series. In the shortterm, incidental durotomy can lead to prolonged hospital stay, meningitis, and low pressure symptoms. In terms of treatment, most will aim to repair the dural tears, which is typically followed by a period of prolonged mandatory bed rest (BR) to reduce the hydrostatic pressure at the repair site. Despite these precautions, persist leaks continue to plague these patients and can be a long-term bothersome problem. A group from Zurich (Switzerland) investigated the incidence of revision surgery following persist cerebrospinal fluid (CSF) leak after surgical inadvertent durotomy repair. In all, 60 patients who underwent lumbar spinal surgery and sustained an incidental durotomy repaired intraoperatively were randomized to receive early ambulation (EA) or 48 hours’ BR postoperatively. There were no differences in age, sex, and preoperative Oswestry Disability Index. Two patients in each group required revision surgery due to persisting CSF leak, one in the BR group required antibiotic treatment for pneumonia, two were treated for postoperative lung oedema, and one sustained multiple embolic strokes. No medical complications were recorded in the EA group. Two patients in the BR group required surgery to treat wound complications. One patient in the EA group required surgery for a persistent wound leak without signs or symptoms of a CSF leak. The study concludes that there is limited benefit in prolonged BR after repair of an incidental durotomy, and that prolonged BR may be associated with significantly more medical complications. While there are clearly limitations to the design and sample size of this small randomized controlled trial, we applaud the authors for adding some high-quality evidence to this difficult debate.