Although early mobilisation after repaired incidental dural tears has similar major complication and reoperation rates compared to later mobilisation, it does, however, significantly decrease the risk of minor complications and length of hospitalisations. This is according to a new systematic review and meta-analysis, the findings of which were presented by Elie Najjar (Nottingham University Hospitals NHS Trust, Nottingham, UK) at the British Association of Spine Surgeons (BASS) 2022 meeting (23–25 March 2022; Belfast, UK).
Najjar et al, whose research was awarded second prize for best study at BASS 2022, had sought to systematically evaluate the relevant literature regarding the outcomes of mobilisation within 24 hours and after 24 hours following an incidental durotomy, with respect to the length of hospital stay, minor complications and reoperation rates.
The researchers undertook a review of the literature up until December 2021 using the search criteria ‘dural tear or durotomy’ and ‘mobilisation or bed rest’ and the PRISMA guidelines. Isolated case reports were excluded.
A total of 243 articles were found, with 11 studies meeting the inclusion criteria (one level I and 10 level IV evidence) and were analysed. Overall, 532 patients (mean age 61.1 years) had an incidental dural tear and were mobilised within 24 hours. Dural repair was performed in 95.3% (507/532) of the cases. The average follow-up period was 23.24 months (3 – 80 months).
The average length of stay (LOS) for the early mobilised patients was 3.65 days. Twenty-one out of 532 (3.9 %) patients (11 studies) required reoperation while the rate of minor complications was 26 out of 230 (11.3%) (nine studies). Additionally, 203 patients of mean age 72 years (seven studies) were mobilised after 24 hours (24–144 hours); 96% (194/202) underwent a primary repair with an average LOS of 6.38 days.
Comparing early to late mobilisation, there was a significant reduction in the risk of minor complications due to early mobilisation (13/102 [12.7%] vs. 33/106 [31.1%], p=0.006; relative risk [RR]: 0.47, confidence interval [CI] 95%: 0.27, 0.80), but no significant difference in major complications and reoperation rates (three studies), (12/106 [11.3%] vs. 11/134 [8.2%], p=0.27; RR: 1.55, 95% CI: 0.72, 3.35). The overall LOS was also shorter for those who undertook early mobilisation (3.65 vs. 6.38 days).
Speaking to Spinal News International, Najjar said: “It was an honour for our team in Queen’s Medical Centre (Nottingham, UK) to win the BASS award. The aim of our review was to break the taboo about dural tear management. The conventional management of prolonged bed rest seems to be not only unnecessary, but harmful in cases in which primary repair was done.
“I hope this paper, which was presented in the BASS meeting and soon at the North American Spine Society (NASS) conference (Chicago, USA), would have a clinical impact on surgeons all over the world, to mobilise their patients as early as possible in cases of repaired incidental dural tears.”