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Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale.
J Neurosurg Pediatr. 2015 May; 15(5):461-4.JN

Abstract

OBJECT

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25658250

Citation

Ogiwara, Hideki, et al. "Duration of the Horizontal Decubitus Position for Prevention of Cerebrospinal Fluid Leakage Following Transection of a Tight Filum Terminale." Journal of Neurosurgery. Pediatrics, vol. 15, no. 5, 2015, pp. 461-4.
Ogiwara H, Joko M, Takado M, et al. Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale. J Neurosurg Pediatr. 2015;15(5):461-4.
Ogiwara, H., Joko, M., Takado, M., Uematsu, K., Kameda, M., Sasaki, N., Kitagawa, M., & Morota, N. (2015). Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale. Journal of Neurosurgery. Pediatrics, 15(5), 461-4. https://doi.org/10.3171/2014.9.PEDS14289
Ogiwara H, et al. Duration of the Horizontal Decubitus Position for Prevention of Cerebrospinal Fluid Leakage Following Transection of a Tight Filum Terminale. J Neurosurg Pediatr. 2015;15(5):461-4. PubMed PMID: 25658250.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale. AU - Ogiwara,Hideki, AU - Joko,Masahiro, AU - Takado,Michiko, AU - Uematsu,Kodai, AU - Kameda,Masahiro, AU - Sasaki,Natsu, AU - Kitagawa,Masashi, AU - Morota,Nobuhito, Y1 - 2015/02/06/ PY - 2015/2/7/entrez PY - 2015/2/7/pubmed PY - 2015/7/21/medline KW - cerebrospinal fluid leakage KW - spine KW - tight filum terminale KW - untethering SP - 461 EP - 4 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 15 IS - 5 N2 - OBJECT: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/25658250/Duration_of_the_horizontal_decubitus_position_for_prevention_of_cerebrospinal_fluid_leakage_following_transection_of_a_tight_filum_terminale_ L2 - https://thejns.org/doi/10.3171/2014.9.PEDS14289 DB - PRIME DP - Unbound Medicine ER -