Recovery for Spinal Lipoma in Children

Postoperative Orders

Neurosurgical management in the postoperative period will vary among clinicians. The following descriptions are based on the senior author’s preference.

• Patient transferred to neurosurgical ward for observation: On completion of the surgical procedure, the patient is extubated and transferred to the neurosurgical ward for observation.
• Regular assessments: During each nursing shift, leg and foot movement is assessed and wound is checked to confirm that the dressing is clean and dry and that there is no subcutaneous CSF collection.
• Positioning in bed: Children are nursed in a flat position (prone, supine, or on side) for 72 hours to reduce tension on the dural closure. Starting from the third postoperative day, patients should return to normal handling (infants) or be mobilized (walkers).
• Bladder catheterization: The urinary catheter remains in place until bowel activity resumes and the child is mobile. Once the urinary catheter is removed, return of effective bladder emptying should be confirmed by measurement of voided urinary volumes and ultrasound assessment of postmicturition volume.
• Analgesia: Intravenous analgesia is typically required in the first 48 hours.
• Antibiotic use: Prophylactic antibiotic regime will be determined according to local policy. The senior author’s preference is for two postoperative antibiotic doses only.

Postoperative Morbidity

The following morbidities specific to lipoma surgery should be considered:

• Wound complications: Due to the location of the surgical wounds, infection and skin breakdown are more common compared with other surgical sites.
• CSF accumulation (pseudomeningocele) or frank CSF leakage.
• Superficial, subcutaneous fat necrosis: This can sometimes occur and can be confused with CSF leakage.
• Pain: In addition to postoperative wound pain, patients who have undergone radical lipoma resection may experience neuropathic pain. Gabapentin is usually effective and is continued following discharge until symptom control has been established.
• Urinary retention: It is important to ensure that adequate bladder emptying has been re-established following removal of the urinary catheter. Patients and parents should be warned that re-catheterization and an extended period of catheter drainage may be required. Some children may need to commence clean intermittent catheterization.
• Constipation: Constipation after spinal surgery is a frequent occurrence. Patients are routinely administered laxatives to aid regular bowel movements.
• Postural, low-pressure headache: This occurs in some patients, but typically it is transient.