![]() In contrast, early group patients had significantly shorter hospital stays after surgery. In addition, the incidence of ileus was significantly higher in the late group. In the cohort presented here, two of the late group patients had pulmonary thromboembolism and deep vein thrombosis. Therefore, early ambulation could prove beneficial however, more evidence is required. Prolonged bed rest causes multiple complications and increases medical expenses. However, there have also been reports that a shortened or even absent bed rest period is not associated with inferior outcomes. In patients with symptoms such as postural headache, several studies have reported that CLC could be prevented by limiting the patient to the prone position for several days after lumbar durotomy. Conventional wisdom suggests that positioning the patient in the prone position after intradural surgery will decrease the CSF pressure at the site of the durotomy, thereby decreasing the flow of CSF through the dural defect. Patient positioning after a durotomy remains controversial. Despite meticulous conservative treatment and close observation, one patient (1.3%) in the early group underwent additional repair surgery due to worsening progression, compared to 18 patients (7.7%) in the late group, a difference that was statistically significant ( p=0.039) ( Table 2). ![]() In the late group, 10 patients had a lumbar drain after surgery, while there were no cases in the early group that required a lumbar drain. CLC including symptomatic pseudomeningocele, durocutaneous fistula, and wound dehiscence with oozing were significantly reduced in the early group (2.5% vs. ![]() There was also no difference in the frequency of hypotensive headache, one of the symptoms of CSF leakage (7.6% vs. There were two cases in the late group and no cases in the early group. The rate of fatal complications such as pulmonary thromboembolism and deep vein thrombosis did not differ significantly between groups. In the early group, the rate of ileus was significantly lower compared to the late group (1.3% vs. Ileus is a complication that may occur in relation to bed rest after surgery. Patients attended a postoperative outpatient clinic at 1 month (or earlier if necessary) and 6 months post-surgery for assessment of clinical symptoms and wound status follow-up. Operations on patients included in the early group were performed by a junior surgeon (name-blinded) and operations on patients in the late group were performed by a senior surgeon (name-blinded). Patients who had surgery due to trauma or infectious causes, extradural lesions, or who had undergone additional anterior surgical procedures, duroplasty, or incomplete dura closure, as well as patients who had simple surgical site infections without CSF leaks were excluded. The inclusion criteria were as follows : 1) patients with intradural tumors or vascular malformations 2) patients who underwent posterior midline approach and durotomy after laminectomy or laminotomy 3) patients in whom primary dura closure was performed and 4) those with a follow-up period ≥6 months. We reviewed all patients who underwent intradural spinal surgery in Asan Medical Center between January 2012 and December 2019. Clinical characteristics, pathology, surgical outcomes, CLC, and surgical repair rate were compared between the groups. Patients who had surgery between January 2012 and December 2018 were included in this group. ![]() In the late group, braided non-absorbable 5-0 black silk sutures with a 10 mm 3/8c round bodied needle (Ailee, Busan, Korea) were used as the dural suture material. Patients who had surgery between March 2018 and December 2019 were included in this group. In the early group, polypropylene 6-0 Prolene sutures with a 9.3 mm 3/8c round bodied needle (Ethicon Inc., Somerville, NJ, USA) were used as the dural suture material. The patients were divided into an early ambulation (early) group, comprising patients who start ambulation on the first day after surgery, and a late ambulation (late) group, comprising patients who start ambulation on the third day after surgery or later, depending on wound status. We conducted a retrospective cohort study to evaluate the effects of dura suture material and postoperative bed rest after intradural spinal surgery. ![]()
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