Early ambulation versus prolonged bed rest for incidental durotomies in spine procedures: a systematic review and meta-analysis.

Autor: Gomes FC; Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil., Larcipretti ALL; Faculty of Medicine, Federal University of Ouro Preto, Ouro Preto, Brazil., Elvir FAR; Santa Casa de Misericordia De Porto Alegre, Porto Alegre, Brazil., Diniz JBC; Neurological Institute of Goiania, Goiania, Brazil., de Melo TMV; Faculty of Medicine, Mauricio de Nassau University Center, Recife, Brazil., Santana LS; Faculty of Medicine, University of São Paulo, São Paulo, Brazil., de Oliveira HM; Faculty of Medicine, Federal University of Mato Grosso, Sinop, Brazil., Barroso DC; Faculty of Medicine, State University of Santa Cruz, Santa Cruz, Brazil., Polverini AD; Neurosurgical Oncology Division, Hospital de Amor, Fundação Pio XII, Antenor Duarte Vilela, 1331 - Dr. Paulo Prata, Barretos, Sao Paulo, 14784-400, Brazil. polverad@gmail.com.
Jazyk: angličtina
Zdroj: Neurosurgical review [Neurosurg Rev] 2023 Nov 22; Vol. 46 (1), pp. 310. Date of Electronic Publication: 2023 Nov 22.
DOI: 10.1007/s10143-023-02201-2
Abstrakt: Incidental durotomies are frequent complications of spine surgery associated with cerebrospinal fluid (CSF) leak-related symptoms. Management typically involves prolonged bed rest to reduce CSF pressure at the durotomy site. However, early ambulation may be a safer, effective alternative. PubMed, Web of Science, Embase, Cochrane, and Scopus were systematically searched for studies comparing early ambulation (bed rest ≤ 24 h) with prolonged bed rest (> 24 h) for patients with incidental durotomies in spine surgeries. The outcomes of interest were CSF leak, hypotensive headache, additional surgical repair, pseudomeningocele, and pulmonary complications. Systematic reviews and meta-analysis were performed following the Cochrane Handbook for Systematic Reviews of Interventions. We included a total of 704 patients from 6 studies. There was a significant reduction in the incidence of pulmonary complications (RR 0.23; 95% CI 0.08-0.67; p = 0.007) in the early mobilization group. The incidence of CSF leak (RR 1.34; 95% CI 0.83-2.14; p = 0.23), hypotensive headache (RR 0.72; 95% CI 0.27-1.90; p = 0.50), additional repair surgery (RR 1.29; 95% CI 0.76-2.2; p = 0.35), and pseudomeningocele (RR 1.29; 95% CI 0.20-8.48; p = 0.79) did not differ significantly. In patients with incidental durotomy following spinal surgery, early mobilization was associated with a lower incidence of pulmonary complications as compared with prolonged bed rest. There was no significant difference between groups in terms of CSF leak, need for additional repair, pseudomeningocele, and hypotensive headache.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: