Mobilization After Repaired Incidental Durotomy During Lumbar Fusion
Abstract: Background: Surgeons commonly prescribe flat bed rest after an incidental dural tear to protect a repair, but prolonged immobility may add medical complications and delay recovery. Published comparisons largely combine decompression with fusion, leaving the fusion-specific effect uncertain. Methods: This targeted narrative review examined a randomized lumbar decompression trial, observational thoracolumbar cohorts, meta-analyses, and a recent posterior lumbar interbody fusion cohort. It focuses on postoperative positioning after an intraoperatively recognized and repaired incidental durotomy, and distinguishes that state from an unresolved postoperative CSF fistula. It is not a registered systematic review. Results: In a 361-patient primary-repair cohort, revision for CSF leak or wound infection was similar with bed rest ≤24 hours and >24 hours (7.87% vs 8.41%); prolonged bed rest had more wound and medical complications and a longer stay. A six-study meta-analysis of 704 patients found fewer pulmonary complications with mobilization ≤24 hours (risk ratio 0.23, 95% CI 0.08-0.67), without statistically significant differences in CSF leak or reoperation; its intervals were compatible with clinically important differences. A small randomized decompression trial reported two CSF-leak revisions in each group. In a 2025 posterior open lumbar interbody fusion cohort, durotomy was associated with longer stay and early morbidity, but mobilization strategies were not randomized or directly compared. Conclusion: Routine flat bed rest beyond 24 hours after a secure repair lacks demonstrated benefit in the available mixed-procedure evidence and is associated with harms. A fusion-specific recommendation remains conditional: repair integrity, persistent leak signs, and reconstruction complexity should be recorded before extrapolating, and symptoms after mobilization require reassessment rather than an automatic fixed duration of bed rest.
Keywords: incidental durotomy; lumbar fusion; early mobilization; bed rest; cerebrospinal fluid leak; pseudomeningocele
How to Cite?: Nishant, "Mobilization After Repaired Incidental Durotomy During Lumbar Fusion", Volume 15 Issue 10, October 2026, International Journal of Science and Research (IJSR), Pages: 494-496, https://www.ijsr.net/getabstract.php?paperid=SR261007151048, DOI: https://dx.doi.org/10.21275/SR261007151048