{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T01:31:44Z","timestamp":1785461504783,"version":"3.56.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Complications after complex tethered spinal cord (cTSC) surgery include infections and cerebrospinal fluid (CSF) leaks. With little empirical evidence to guide management, there is variability in the interventions undertaken to limit complications. Expert-based best practices may improve the care of patients undergoing cTSC surgery. Here, authors conducted a study to identify consensus-driven best practices.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The Delphi method was employed to identify consensual best practices. A literature review regarding cTSC surgery together with a survey of current practices was distributed to 17 board-certified pediatric neurosurgeons. Thirty statements were then formulated and distributed to the group. Results of the second survey were discussed during an in-person meeting leading to further consensus, which was defined as \u2265 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Seventeen consensus-driven best practices were identified, with all participants willing to incorporate them into their practice. There were four preoperative interventions: (1, 2) asymptomatic AND symptomatic patients should be referred to urology preoperatively, (3, 4) routine preoperative urine cultures are not necessary for asymptomatic AND symptomatic patients. There were nine intraoperative interventions: (5) patients should receive perioperative cefazolin or an equivalent alternative in the event of allergy, (6) chlorhexidine-based skin preparation is the preferred regimen, (7) saline irrigation should be used intermittently throughout the case, (8) antibiotic-containing irrigation should be used following dural closure, (9) a nonlocking running suture technique should be used for dural closure, (10) dural graft overlay should be used when unable to obtain primary dural closure, (11) an expansile dural graft should be incorporated in cases of lipomyelomeningocele in which primary dural closure does not permit free flow of CSF, (12) paraxial muscles should be closed as a layer separate from the fascia, (13) routine placement of postoperative drains is not necessary. There were three postoperative interventions: (14) postoperative antibiotics are an option and, if given, should be discontinued within 24 hours; (15) patients should remain flat for at least 24 hours postoperatively; (16) routine use of abdominal binders or other compressive devices postoperatively is not necessary. One intervention was prioritized for additional study: (17) further study of additional gram-negative perioperative coverage is needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>A modified Delphi technique was used to develop consensus-driven best practices for decreasing wound complications after cTSC surgery. Further study is required to determine if implementation of these practices will lead to reduced complications. Discussion through the course of this study resulted in the initiation of a multicenter study of gram-negative surgical site infections in cTSC surgery.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.6.peds18243","type":"journal-article","created":{"date-parts":[[2018,9,14]],"date-time":"2018-09-14T13:56:01Z","timestamp":1536933361000},"page":"701-709","source":"Crossref","is-referenced-by-count":11,"title":["Development of best practices to minimize wound complications after complex tethered spinal cord surgery: a modified Delphi study"],"prefix":"10.3171","volume":"22","author":[{"given":"Nikita G.","family":"Alexiades","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward S.","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Blount","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama, Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas L.","family":"Brockmeyer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Primary Children\u2019s Hospital, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel R.","family":"Browd","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Washington Seattle Children\u2019s Hospital, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald A.","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory G.","family":"Heuer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital of Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd C.","family":"Hankinson","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Children\u2019s Hospital Colorado, Anschutz Medical Campus, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bermans J.","family":"Iskandar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Jea","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Krieger","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, USC Keck School of Medicine\/Children\u2019s Hospital of Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey R.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nationwide Children\u2019s Hospital, The Ohio State University College of Medicine, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David D.","family":"Limbrick","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cormac O.","family":"Maher","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark R.","family":"Proctor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Boston, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David I.","family":"Sandberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School\/University of Texas Health Science Center, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Wellons","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; 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