title: Pilot study of perioperative accidental durotomy: does the period of postoperative bed rest reduce the incidence of complication?
abstract: BACKGROUND
  An accidental durotomy is a recognised and not infrequent complication of lumbar spine surgery, and may lead to postoperative low-pressure headaches, pseudomeningocele and CSF leak. Conventional postoperative management involves a period of flat bed rest. There is no agreement as to the need for and duration of postoperative bed rest. This study aims to determine whether the duration of flat bed rest alters the rate of these complications.
  
  
  METHODS
  This is a retrospective study. All patients who underwent surgery for degenerative spinal disease between May 2010 and May 2011 were reviewed. All patients who incurred an accidental durotomy and who were repaired using fibrin glue were included in this study. Their notes were reviewed for evidence of complications for a minimum of 12 months after surgery. The following complications were identified: postural headache, pseudomeningocele, CSF leak wound infection, subdural haematoma.
  
  
  RESULTS
  Eight hundred and eighty-nine patients underwent lumbar spine surgery. Sixty-one (6.8%) patients suffered an accidental durotomy and were repaired with fibrin glue. Twenty-six patients were mobilised on the first postoperative day, 9 patients on the second, and a further 26 patients were mobilised on the third postoperative day or later. The overall incidence of complications related to the durotomy was 18%. There was no statistical significance between the day of mobilisation and the rate of complication (p = 0.433).
  
  
  CONCLUSIONS
  A longer period of mandatory bed rest does not decrease the rate of complications. Patients should be mobilised as soon as they can. This could potentially reduce the length of hospital stay and the cost of aftercare.
authors.affiliation: Department of Neurosurgery, Salford Royal NHS Foundation Trust , Salford , UK.
authors.forename: Jacob Chen Ming
authors.initials: JC
authors.lastname: Low
authors.forename: Belinda
authors.initials: B
authors.lastname: von Niederhäusern
authors.forename: Scott A
authors.initials: SA
authors.lastname: Rutherford
authors.forename: Andrew T
authors.initials: AT
authors.lastname: King
mesh_terms: D001510:Bed Rest; D015331:Cohort Studies; D004388:Dura Mater / Q000293:injuries*; D004434:Early Ambulation; D005260:Female; D015718:Fibrin Tissue Adhesive; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D019636:Neurodegenerative Diseases / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010865:Pilot Projects; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery; D014014:Tissue Adhesives
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives