Minimizing CSF Leak and Wound Complications in Tethered Cord Surgery with Prone Positioning: Outcomes in 350 Patients

We document the results of a protocol to reduce the incidence of cerebrospinal fluid (CSF) leak and other wound complications in patients undergoing tethered cord surgery (TCS).

Data from all patients undergoing TCS between January 2009 and April 2019 were reviewed retrospectively. Diagnosis (high risk or low risk; based on the presence of fascial and dural defects at surgery), type of graft used for dural or fascial repair, and CSF leak and other wound complications in the postoperative period were noted. All patients were nursed in the prone position with elevation of the foot end of the bed (Trendelenburg position) for at least 5 days after surgery with a subfascial drain in place.

Of a total of 350 patients (191 high risk; 159 low risk), CSF leak from the wound was noted in 16 (4.5%). All but 4 of these patients were managed with wound suturing with or without insertion of a subcutaneous drain with continued nursing in the prone and Trendelenburg position. Two patients had meningitis and 3 patients had wound infection. Multivariate analysis revealed that the use of synthetic grafts (P < 0.000) and inability to close the dura (P = 0.02) were the only significant risk factors for CSF wound leak. Wound infections and/or dehiscence were noted in 17 (4.8%) other patients.

Postoperative prone nursing with Trendelenburg position minimizes the incidence of CSF leak and other wound complications.