Recovery From Surgery for Tethered Cord Syndrome With a Normally Positioned Conus in Children

Postoperative Orders 

• HOB, positioning, activity, bathing: The patient is kept flat on bed rest for 3 days to allow for dural healing and to put as little CSF pressure on the dura as possible during this time. The authors prefer to limit bathing to a sponge bath until the patient is seen in clinic 1 week later.
• Foley catheter removed on postoperative day one. If the child fails to void, in-and-out catheterization is performed every 4 hours until post-void residual returns to normal limits for age.
• Bandage left over wound: The authors prefer to leave the dressing in place until the patient returns for the postoperative clinic visit 1 week later. The dressing should be observed for CSF leakage. In an infant a mud flap just below the wound is desired to prevent stool and urine from contaminating the wound.
• Acetaminophen or ibuprofen: A regimen of alternating doses of ibuprofen and acetaminophen, both at 10 mg/kg every 4–6 hours as needed, is effective in managing postoperative pain.
• Laboratory studies: None
• Radiology studies: None
• Physical therapy and orthotics: None
• Consultations: None

Postoperative Morbidity

• Lower pressure headache: The patient is kept flat, and the head is slowly elevated over several days.
• Incisional pain: Postoperative incisional pain is treated with oral analgesics such as ibuprofen or acetaminophen while the patient is in the hospital. After discharge, these medications may be continued as needed for a few additional days.