# Cerebrospinal Fluid Leaks and Healthcare Costs Associated With Tethered Cord Release and Filum Terminale Sectioning

## TL;DR

This study compares healthcare costs and CSF leaks in pediatric patients after spinal cord surgery, finding no significant differences between two postoperative positioning strategies.

## Contribution

The study provides new insights into the economic and clinical outcomes of postoperative positioning after tethered cord release in children.

## Key findings

- CSF leak rates were 2.8% and 4% in the two cohorts, with no statistically significant difference.
- Hospital costs were $13,742 and $14,650 for the two groups, with no significant difference.
- Postoperative infections were more common in the cohort kept in the recumbent position for zero days.

## Abstract

Introduction: Tethered cord syndrome is a condition caused by anatomical restrictions that limit the normal movement of the spinal cord, resulting in metabolic and vascular abnormalities that lead to hypoxia and jeopardize function. This study aims to comprehensively analyze the incidence of cerebrospinal fluid (CSF) leaks and the economic burden in pediatric patients who have undergone tethered cord release (TCR) and sectioning of filum terminale, stratified by the duration of postoperative recumbency.

Methods: After approval from the Institutional Review Board, a retrospective chart review of a tertiary medical center was performed. Patients were stratified into two cohorts based on the time spent in the recumbent position (cohort 1: zero days vs. cohort 2: greater than or equal to one day).

Results: Cohort 1 (n = 35) had a mean age of 9.14 ± 2.51 years, and cohort 2 (n = 25) had a mean age of 3.94 ± 0.87 years. The mean procedure duration was shorter in cohort 1 at 2.318 hours (1.22-4.63 hours) compared to 2.74 hours (2.20-3.97 hours) in cohort 2. CSF leaks were observed in one patient in cohort 1 (2.8%) and one patient in cohort 2 (4%), which was determined to be statistically insignificant through Fisher’s exact test (p > 0.99). Cohort 1 had a higher overall frequency of total postsurgical complications with six patients (17.1%) compared to three patients in cohort 2 (12%) (p = 0.72). The most common complication was postsurgical infections, which occurred in four patients in cohort 1 (11%) and one in cohort 2 (4%). Mean postoperative hospital stays were 1.969 days for cohort 1 and 1.68 days for cohort 2. The inpatient hospital costs accrued and calculated in 2024 U.S. dollars were $13,742 and $14,650 for cohorts 1 and 2, respectively (p = 0.79).

Conclusion: The increased burden and inpatient days needed to place patients in the supine position post-TCR are likely not justified in the setting of comparable CSF leak rates.