Bed rest duration and development of cerebrospinal fluid leaks after intradural spinal surgery: a meta-analysis of comparative studies.

Abstract

Introduction: Postoperative cerebrospinal fluid (CSF) leaks and related complications are a major concern after intradural spinal surgeries. The role of prolonged bed rest in reducing the incidence of these complications has been debated. This meta-analysis aimed to evaluate whether early versus late mobilization affects the incidence of CSF leak-related complications (CLRC) after intradural spinal surgery.

Evidence acquisition: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of comparative studies on early ambulation (EA) versus prolonged bed rest (PBR) in patients undergoing intradural spinal surgery. Studied considered for inclusion defined EA as mobilization on postoperative day 1, while PBR as mobilization on postoperative day 3. The primary outcome was the incidence of CLRC, defined as pseudomeningocele, durocutaneous fistula, or wound dehiscence. Secondary outcome was the incidence of medical complications.

Evidence synthesis: Three retrospective comparative studies with a total of 949 patients were included in the analysis. No significant difference was found in the incidence of CLRC between the EA and PBR groups. Length of hospital stay (LOS) and postoperative medical complications incidence were significantly lower in the EA group.

Conclusions: This meta-analysis found that EA does not increase the risk of CLRC compared to PBR, while shortening LOS and reducing medical complications occurrence. These findings suggest that early mobilization could be a safe and effective postoperative strategy, reducing hospital stay and complication rates.