{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T09:57:27Z","timestamp":1775901447895,"version":"3.50.1"},"reference-count":43,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>No evidence-based guideline has been approved for the postoperative management of pediatric patients with tethered cord syndrome (TCS). The purpose of this randomized clinical trial was to evaluate the effectiveness of prone positioning and acetazolamide administration on complication rates following spinal cord untethering surgeries.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>From October 2012 to February 2015, patients with a primary diagnosis of TCS who were admitted to the Children's Medical Center Hospital of Iran were randomly allocated to 1 of 4 intervention modality groups postoperatively: 1) Group A, acetazolamide administration for 10 days; 2) Group B, prone positioning for 10 days; 3) Group C, acetazolamide administration and prone positioning for 10 days; and 4) Group D, no intervention. CSF leakage, CSF collection, wound dehiscence, operative site infection, and secondary surgical wound repair were considered failure.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 161 patients were enrolled in this study (Group A, n = 39 [24.2%]; Group B, n = 41 [25.5%]; Group C, n = 39 [24.2%]; and Group D, n = 42 [26.1%]). The overall failure rate was 12.42% (20 patients). Complication rates through pooled analyses were as follows: CSF leakage (n = 9, 5.6%), CSF collection (n = 12, 7.5%), wound dehiscence (n = 2, 1.2%), and infection of operation site (n = 3, 1.9%). Two patients (1.2%) required surgical secondary wound repair due to complications. CSF leakage and collection rates were significantly lower in patients who underwent prone positioning (p = 0.042 and 0.036, respectively). The administration of acetazolamide, either isolated or in combination with prone positioning, not only could not significantly lower the complication rates, but also added the burden of side effects.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The current study demonstrates the possible role of prone positioning in mitigating the complication rates subsequent to untethering surgeries.<\/jats:p>\n<jats:p>Clinical trial registration no.: NCT01867268 (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"clinicaltrials.gov\" ext-link-type=\"uri\" xlink:type=\"simple\">clinicaltrials.gov<\/jats:ext-link>)<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.8.peds15393","type":"journal-article","created":{"date-parts":[[2016,1,29]],"date-time":"2016-01-29T14:59:57Z","timestamp":1454079597000},"page":"659-666","source":"Crossref","is-referenced-by-count":20,"title":["Randomized clinical trial of acetazolamide administration and\/or prone positioning in mitigating wound complications following untethering surgeries"],"prefix":"10.3171","volume":"17","author":[{"given":"Shima","family":"Shahjouei","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Children's Hospital Medical Center, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Hanaei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children's Hospital Medical Center, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zohreh","family":"Habibi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children's Hospital Medical Center, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mostafa","family":"Hoseini","sequence":"additional","affiliation":[{"name":"Department of Statistics and Epidemiology, Tehran University of Medical Science, Tehran, Iran; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saeed","family":"Ansari","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Florida, Gainesville, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farideh","family":"Nejat","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children's Hospital Medical Center, and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-peds15393","series-title":"Acta Med Iran","first-page":"467","article-title":"Analysing the effect of early acetazolamide administration on patients with a high risk of permanent cerebrospinal fluid leakage","volume":"51","author":"Abrishamkar","year":"2013"},{"key":"b2-peds15393","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"181","DOI":"10.3171\/2008.12.PEDS0874","article-title":"Tethered cord release: a long-term study in 114 patients","volume":"3","author":"Bowman","year":"2009"},{"issue":"8 Suppl","key":"b3-peds15393","series-title":"Spine (Phila Pa 1976)","first-page":"S319","article-title":"The histomorphologic sequence of dural repair. 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