Perioperative risk factors predicting CSF leak and retethering following tethered cord release for complex spinal
Kelsi M Chesney1, Joseph H McAbee1,2, Alan Balu3
1Department of Neurosurgery, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA.
Insights
Children undergoing tethered cord release (TCR) for spinal lipomas face higher risks of cerebrospinal fluid (CSF) leaks and retethering if they are older, symptomatic, or had prior detethering. Nurolon sutures may increase leak risk.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Spinal Surgery
Background:
- Tethered cord release (TCR) is a common procedure for complex spinal lipomas in children.
- Postoperative cerebrospinal fluid (CSF) leaks are a known complication, with reported rates up to 33%.
Purpose of the Study:
- To identify perioperative risk factors for CSF leaks and retethering after TCR in pediatric patients with complex spinal lipomas.
- To aid in predicting higher-risk patients for improved surgical outcomes.
Main Methods:
- Retrospective review of 131 pediatric patients who underwent 168 TCR procedures for complex spinal lipomas between 1996 and 2023.
- Analysis of patient demographics, surgical techniques (dural closure materials), postoperative management, and clinical outcomes.
Main Results:
- Fifteen patients (8.9%) experienced postoperative CSF leaks.
- Increased leak risk was associated with older age (11.2 vs. 1.2 years), symptomatic presentation, and prior detethering.
- Nurolon sutures showed a higher leak rate compared to Prolene; postoperative positioning did not significantly impact leak rates.
- CSF leak patients had longer hospital stays, higher infection rates, and increased retethering likelihood.
Conclusions:
- Older age, symptomatic presentation, and prior detethering are risk factors for CSF leaks and retethering after TCR in pediatric complex spinal lipomas.
- Nurolon suture use for dural closure may increase CSF leak risk.
- Early mobilization may be safe as lying flat for fewer days did not increase leak risk.
Purpose:
Tethered cord release (TCR) is typically well tolerated in children, but cerebrospinal fluid (CSF) leaks can occur postoperatively, with rates as high as 33%. The aim of this study was to determine perioperative risk factors associated with CSF leaks and retethering following TCR for complex spinal lipomas to predict higher risk patients.
Methods:
A retrospective review was performed for complex spinal lipoma patients who underwent TCR at Children's National Hospital from 1996 to 2023. Demographics, operative techniques, postoperative management, and outcomes were analyzed.
Results:
A total of 131 patients with complex spinal lipomas underwent 168 operations for TCR. Fifteen patients experienced a postoperative CSF leak (8.9%). Patients with an increased leak risk were significantly older (11.2 vs. 1.2 years), presented symptomatically, and had a history of prior detethering. A significantly higher number of leaks was observed after dural closure with Nurolon sutures compared to Prolene. Lying flat postoperatively for fewer days did not influence leak rates. Leak patients experience significantly longer hospital stays, higher wound infection rates, and a higher likelihood of retethering. Patients with preoperative symptoms, prior TCR, and transitional lipomas had a lower PFS and were more likely to retether after TCR.
Conclusion:
Children undergoing TCR for complex spinal lipomas may be at higher risk of CSF leak if they are older, underwent prior detethering, or presented symptomatically. Nurolon sutures may increase leak risk compared with Prolene. Interestingly, lying flat for fewer days postoperatively did not increase leak risk, suggesting patients may be able to safely mobilize sooner.
