{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:15:34Z","timestamp":1793391334518,"version":"4.5.0"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T00:00:00Z","timestamp":1705449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Prolonged bed rest after the resection of spinal intradural tumors is postulated to mitigate the development of cerebrospinal fluid leaks (CSFLs), which is one of the feared postoperative complications. Nonetheless, the empirical evidence supporting this conjecture remains limited and requires further investigation. The goal of the study was to investigate whether prolonged bed rest lowers the risk of CSFL after the resection of spinal intradural tumors. The primary outcome was the rate of CSFL in each cohort. Materials and Methods: To validate this hypothesis, we conducted a comparative effectiveness research (CER) study at two distinct academic neurosurgical centers, wherein diverse postoperative treatment protocols were employed. Specifically, one center adopted a prolonged bed rest regimen lasting for three days, while the other implemented early postoperative mobilization. For statistical analysis, case\u2013control matching was performed. Results: Out of an overall 451 cases, we matched 101 patients from each center. We analyzed clinical records and images from each case. In the bed rest center, two patients developed a CSFL (n = 2, 1.98%) compared to four patients (n = 4, 3.96%) in the early mobilization center (p = 0.683). Accordingly, CSFL development was not associated with early mobilization (OR 2.041, 95% CI 0.365\u201311.403; p = 0.416). Univariate and multivariate analysis identified expansion duraplasty as an independent risk factor for CSFL (OR 60.33, 95% CI: 0.015\u20130.447; p &lt; 0.001). Conclusions: In this CER, we demonstrate that early mobilization following the resection of spinal intradural tumors does not confer an increased risk of the development of CSFL.<\/jats:p>","DOI":"10.3390\/medicina60010171","type":"journal-article","created":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T07:41:28Z","timestamp":1705477288000},"page":"171","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Does Early Mobilization Following Resection of Spinal Intra-Dural Pathology Increase the Risk of Cerebrospinal Fluid Leaks?\u2014A Dual-Center Comparative Effectiveness Research"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4062-4785","authenticated-orcid":false,"given":"Michael","family":"Schwake","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Krahwinkel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Gallus","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Schipmann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Department of Neurosurgery, University Hospital Bergen, 5009 Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Maragno","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Neuschmelting","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Perrech","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9427-5555","authenticated-orcid":false,"given":"Michael","family":"M\u00fcther","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0788-4681","authenticated-orcid":false,"given":"Moritz","family":"Lenschow","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.21037\/atm.2019.01.04","article-title":"Cerebrospinal fluid leaks after spine tumor resection: Avoidance, recognition and management","volume":"7","author":"Barber","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"799","DOI":"10.3340\/jkns.2020.0350","article-title":"Reliability of Early Ambulation after Intradural Spine Surgery: Risk Factors and a Preventive Method for Cerebrospinal Fluid Leak Related Complications","volume":"64","author":"Lee","year":"2021","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/BSD.0b013e31827d7ad8","article-title":"Complications of Flat Bed Rest After Incidental Durotomy","volume":"29","author":"Radcliff","year":"2016","journal-title":"Clin. Spine Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s00381-013-2276-4","article-title":"CSF complications following intradural spinal surgeries in children","volume":"30","author":"Liu","year":"2014","journal-title":"Childs Nerv. Syst."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e1190","DOI":"10.1016\/j.wneu.2022.05.129","article-title":"Risk Factors for Postoperative Cerebrospinal Fluid Leakage After Intradural Spine Surgery","volume":"164","author":"Jesse","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.clineuro.2015.10.013","article-title":"A short review on a complication of lumbar spine surgery: CSF leak","volume":"139","author":"Menon","year":"2015","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1227\/neu.0000000000002448","article-title":"The Role of Prolonged Bed Rest in Postoperative Cerebrospinal Fluid Leakage after Surgery of Intradural Pathology\u2014A Retrospective Cohort Study","volume":"93","author":"Krahwinkel","year":"2023","journal-title":"Neurosurgery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.3171\/2022.1.JNS212514","article-title":"The impact of resection in IDH-mutant WHO grade 2 gliomas: A retrospective population-based parallel cohort study","volume":"137","author":"Jakola","year":"2022","journal-title":"J. Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"523","DOI":"10.3171\/jns.1990.72.4.0523","article-title":"Intramedullary ependymoma of the spinal cord","volume":"72","author":"McCormick","year":"1990","journal-title":"J. Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.wneu.2011.12.085","article-title":"Complications necessitating a return to the operating room following intradural spine surgery","volume":"78","author":"Hoover","year":"2012","journal-title":"World Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e497","DOI":"10.1016\/j.wneu.2018.08.112","article-title":"Cerebrospinal Fluid Leak and Symptomatic Pseudomeningocele after Intradural Spine Surgery","volume":"120","author":"Sellin","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"959533","DOI":"10.3389\/fsurg.2022.959533","article-title":"Cerebrospinal fluid leaks following intradural spinal surgery\u2014Risk factors and clinical management","volume":"9","author":"Lenschow","year":"2022","journal-title":"Front. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.spinee.2013.06.044","article-title":"Comparison of dural repair techniques","volume":"15","author":"Dafford","year":"2015","journal-title":"Spine J."},{"key":"ref_15","first-page":"216","article-title":"Cerebrospinal fluid leaks after planned intradural spine surgery: A single-center analysis of 91 cases","volume":"74","author":"Koechlin","year":"2013","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"698","DOI":"10.3171\/jns.1976.44.6.0698","article-title":"Body position and cerebrospinal fluid pressure. Part 2: Clinical studies on orthostatic pressure and the hydrostatic indifferent point","volume":"44","author":"Magnaes","year":"1976","journal-title":"J. Neurosurg."},{"key":"ref_17","first-page":"377","article-title":"Identification of Risk Factors for Postoperative Cerebrospinal Fluid Leakage and Comparison of Two Alternative Dural Augmentation Techniques in Posterior Fossa and Spinal Surgeries","volume":"29","author":"Eser","year":"2019","journal-title":"Turk. Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Jesse, C.M., Alvarez Abut, P., Wermelinger, J., Raabe, A., Sch\u00e4r, R., and Seidel, K. (2022). Functional Outcome in Spinal Meningioma Surgery and Use of Intraoperative Neurophysiological Monitoring. Cancers, 14.","DOI":"10.3390\/cancers14163989"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"279","DOI":"10.3171\/2014.3.SPINE13719","article-title":"Management of intended durotomy in minimally invasive intradural spine surgery: Clinical article","volume":"21","author":"Tan","year":"2014","journal-title":"J. Neurosurg. Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.3171\/2021.5.JNS21369","article-title":"A standardized model for in vitro testing of sutures and patches for watertight dural closure","volume":"136","author":"Ebel","year":"2021","journal-title":"J. Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1097\/BRS.0000000000000810","article-title":"Spinal sealant system provides better intraoperative watertight closure than standard of care during spinal surgery: A prospective, multicenter, randomized controlled study","volume":"40","author":"Wright","year":"2015","journal-title":"Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1093\/neuros\/nyx216","article-title":"Safety and Efficacy of a Novel, Self-Adhering Dural Substitute in a Canine Supratentorial Durotomy Model","volume":"82","author":"Lewis","year":"2018","journal-title":"Neurosurgery"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1007\/s00701-011-1197-9","article-title":"Study of dural suture watertightness: An in vitro comparison of different sealants","volume":"153","author":"Chauvet","year":"2011","journal-title":"Acta Neurochir."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.wneu.2017.08.061","article-title":"Comparison of Porcine and Bovine Collagen Dural Substitutes in Posterior Fossa Decompression for Chiari I Malformation in Adults","volume":"108","author":"Lee","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.wneu.2018.12.033","article-title":"Safety and Efficacy of Laminoplasty Versus Laminectomy in the Treatment of Spinal Cord Tumors: A Systematic Review and Meta-Analysis","volume":"125","author":"Sun","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"487","DOI":"10.3340\/jkns.2019.0191","article-title":"Postoperative Non-Pathological Fever following Posterior Cervical Fusion Surgery: Is Laminoplasty a Better Preventive Method than Laminectomy?","volume":"63","author":"Lee","year":"2020","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.wneu.2013.11.012","article-title":"Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foraminotomy, discectomy, or laminectomy","volume":"81","author":"Wong","year":"2014","journal-title":"World Neurosurg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1093\/neuros\/nyx253","article-title":"Minimally Invasive Microsurgical Resection of Primary, Intradural Spinal Tumors is Feasible and Safe: A Consecutive Series of 83 Patients","volume":"82","author":"Formo","year":"2018","journal-title":"Neurosurgery"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.spinee.2021.01.001","article-title":"Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery after Surgery (ERAS\u00ae) Society recommendations","volume":"21","author":"Debono","year":"2021","journal-title":"Spine J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.wneu.2019.06.181","article-title":"Enhanced Recovery after Surgery (ERAS) for Spine Surgery: A Systematic Review","volume":"130","author":"Dietz","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"221","DOI":"10.3171\/2019.7.SPINE181104","article-title":"The MISDEF2 algorithm: An updated algorithm for patient selection in minimally invasive deformity surgery","volume":"32","author":"Mummaneni","year":"2020","journal-title":"J. Neurosurg. Spine"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/1\/171\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:48:51Z","timestamp":1760104131000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/1\/171"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,17]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["medicina60010171"],"URL":"https:\/\/doi.org\/10.3390\/medicina60010171","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,17]]}}}