Does Early Mobilization Following Resection of Spinal Intra-Dural Pathology Increase the Risk of Cerebrospinal Fluid Leaks?—A Dual-Center Comparative Effectiveness Research
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Surgical Procedure
2.3. Statistics
3. Results
4. Discussion
- 1.
- Localization of tumors
- 2.
- Dura closure
- 3.
- Laminectomy versus hemilaminectomy
- 4.
- Limitation
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Center 1 (No Bed Rest) n = 101 | Center 2 (Bed Rest) n = 101 | p Value | |
---|---|---|---|
Female sex (N, %) | 50 (49.0%) | 44 (43.6%) | 0.481 |
Age (Mean, ±SD) | 40.47 (±12.6) years | 57.89 (±15.6) years | <0.001 |
Relationship to the spinal cord | 0.310 | ||
Intramedullary (N, %) | 26 (25.7%) | 19 (18.8%) | |
Juxtamedullary (N, %) | 75 (74.3%) | 82 (81.2%) | |
Level in the spine (N, %) | 0.169 | ||
Cranial to T-6 (N, %) | 17 (16.8%) | 26 (25.7%) | |
Caudal to T-6 (N, %) | 84 (83.2%) | 75 (74.4%) | |
Spinal region | 0.207 | ||
Cervical spine (N, %) | 4 (36.4%) | 7 (63.6%) | |
Thoracic spine (N, %) | 41 (45.1%) | 50 (54.9%) | |
Lumbar spine (N, %) | 56 (56.0%) | 44 (44.0%) | |
Surgical indication | 0.002 | ||
Arteriovenous fistula (N, %) | 1 (0.99%) | 4 (3.96%) | |
Intramedullary ependymoma (N, %) | 12 (11.88%) | 9 (8.91%) | |
Juxtamedullary ependymoma (N, %) | 16 (15.84%) | 3 (2.97) | |
Hemangioblastoma (N, %) | 6 (5.94%) | 3 (2.97) | |
Meningioma (N, %) | 14 (13.86%) | 38 (37.62%) | |
Metastasis (N, %) | 6 (5.94%) | 4 (3.96%) | |
Nerve sheath tumor (N, %) | 5 (4.95%)) | 4 (3.96%) | |
Neurinoma (N, %) | 29 (28.71%) | 23 (22.77%) | |
Other (N, %) | 11 (10.89%) | 13 (12.87%) | |
Preoperative neurological status (McCormick scale) (N, %) | 0.006 | ||
1 | 54 (53.6%) | 57 (56.4%) | |
2 | 18 (17.8%) | 33 (32.7%) | |
3 | 16 (15.8%) | 6 (5.9%) | |
4 | 10 (9.9%) | 2 (2.0%) | |
5 | 3 (3.0%) | 3 (3.0%) |
Center 1 (No Bed Rest) n = 101 | Center 2 (Bed Rest) n = 101 | p Value | |
---|---|---|---|
Duration of surgery (Mean, ±SD) | 240.77 (±104.9) min. | 228.32 (±107.6) min. | 0.426 |
Surgical approach | >0.999 | ||
Laminectomy (N, %) | 9 (9.9%) | 9 (9.9%) | |
Non laminectomy (N, %) | 92 (91.1%) | 92 (91.1%) | |
Dura closure | 0.806 | ||
Direct suture ± sealant (N, %) | 93 (92.1%) | 91 (90.1%) | |
Expansion duraplasty (N, %) | 8 (7.9%) | 10 (9.9%) | |
Primary surgery | 0.481 | ||
Yes (N, %) | 89 (88.1%) | 92 (91.1%) | |
No (N, %) | 12 (11.9%) | 8 (7.9%) |
Center 1 (No Bed Rest) n = 101 | Center 2 (Bed Rest) n = 101 | p Value | |
---|---|---|---|
Postoperative neurological status (McCormick scale) (N, %) | 0.014 | ||
1 | 55 (54.5%) | 63 (62.4%) | |
2 | 17 (16.8%) | 28 (27.7%) | |
3 | 16 (15.8%) | 6 (5.9%) | |
4 | 10 (9.9%) | 3 (3.0%) | |
5 | 3 (3.0%) | 1 (1.0%) | |
Bed rest (N, %) | 0 (0%) | 101 (100%) | <0.001 |
Cerebrospinal fluid leakage | 0.683 | ||
Yes (N, %) | 4 (4.0%) | 2 (2%) | |
No (N, %) | 97 (96%) | 99 (98%) | |
Length of hospital stay (Mean, ±SD) | 7.39 (±6.3) days | 8.20 (±7.3) days | 0.399 |
Complications | |||
Wound infection (N, %) | 1 (1.0%) | 6 (5.9%) | 0.119 |
Urinary tract infection (N, %) | 1 (1.0%) | 0 | >0.999 |
Deep venous thrombosis (N, %) | 1 (1.0%) | 0 | >0.999 |
Other (N, %) | 7 (6.9%) | 5 (5.0%) | >0.999 |
With CSFL (n = 6) | Without CSFL (n = 196) | p Value | |
---|---|---|---|
Sex | >0.999 | ||
Male (N, %) | 3 (3.2%) | 91 (96.8%) | |
Female (N, %) | 3 (2.8%) | 105 (97.2%) | |
Localization | >0.999 | ||
Intramedullary (N, %) | 1 (2.2%) | 44 (97.8%) | |
Juxtamedullary (N, %) | 5 (3.2%) | 152 (96.8%) | |
Surgical approach | 0.091 | ||
Laminectomy (N, %) | 2 (11.1%) | 16 (88.9%) | |
Non-laminectomy (N, %) | 4 (2.2%) | 180 (97.8%) | |
Primary surgery | 0.110 | ||
Yes (N, %) | 4 (2.2%) | 178 97.8%) | |
No (N, %) | 2 (10.0%) | 18 (90.0%) | |
Dura closure | 0.010 | ||
Direct suture ± sealant (N, %) | 3 (1.6%) | 181 (98.4%) | |
Expansion duraplasty (N, %) | 3 (16.7%) | 15 (83.3%) | |
Bed rest | 0.683 | ||
Yes (N, %) | 2 (2.0%) | 99 (98.0%) | |
No (N, %) | 4 (4.0%) | 97 (96.0%) | |
Level in the spine | >0.999 | ||
Cranial to T-6 | 1 (2.3%) | 42 (97.7%) | |
Caudal to T-6 | 5 (3.1%) | 154 (96.9%) |
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Schwake, M.; Krahwinkel, S.; Gallus, M.; Schipmann, S.; Maragno, E.; Neuschmelting, V.; Perrech, M.; Müther, M.; Lenschow, M. Does Early Mobilization Following Resection of Spinal Intra-Dural Pathology Increase the Risk of Cerebrospinal Fluid Leaks?—A Dual-Center Comparative Effectiveness Research. Medicina 2024, 60, 171. https://doi.org/10.3390/medicina60010171
Schwake M, Krahwinkel S, Gallus M, Schipmann S, Maragno E, Neuschmelting V, Perrech M, Müther M, Lenschow M. Does Early Mobilization Following Resection of Spinal Intra-Dural Pathology Increase the Risk of Cerebrospinal Fluid Leaks?—A Dual-Center Comparative Effectiveness Research. Medicina. 2024; 60(1):171. https://doi.org/10.3390/medicina60010171
Chicago/Turabian StyleSchwake, Michael, Sophia Krahwinkel, Marco Gallus, Stephanie Schipmann, Emanuele Maragno, Volker Neuschmelting, Moritz Perrech, Michael Müther, and Moritz Lenschow. 2024. "Does Early Mobilization Following Resection of Spinal Intra-Dural Pathology Increase the Risk of Cerebrospinal Fluid Leaks?—A Dual-Center Comparative Effectiveness Research" Medicina 60, no. 1: 171. https://doi.org/10.3390/medicina60010171