Tethered Cord Evaluation and Perioperative Management — Simple Tethered Cord Post-Op — Clinical Pathway: Inpatient and Primary Care

Tethered Cord Evaluation and Perioperative Management Clinical Pathway — Inpatient and Primary Care

Simple Tethered Cord Post-Op

Medical/Surgical Floor Level of Care: Day #0 Through Discharge

  • Goals for Day #0 Through Discharge:
    • Maintain calm child; avoid spinal pressure elevations
    • Wound care PRN
    • Pain management
    • Avoid constipation
Pain Management
  • Scheduled:
    • Acetaminophen IV or PO x 24 hrs
  • PRN:
    • Diazepam POD #1 (spasm)
    • Oxycodone (severe pain)
    • Ibuprofen, if eligible (avoid in children with renal disease)
Neuro Assessments
and Vital Signs		 Neuro checks and vitals signs q4 hrs
Activity/Physical Therapy Recommendations
  • Flat lying and calm overnight
  • Calm most important, allow family to hold smaller children if needed
  • No upright positioning
Nutrition
  • Clears and advance as tolerated
  • IV + PO
  • I&O
  • Bowel regimen
Dressing
Post-op Antibiotics
Not recommended		 Perioperative Antibiotic Prophylaxis
Discharge Criteria
  • Tolerating PO
  • Pain management controlled
  • Family education
Discharge Planning
  • Dressings may be required for home patients with bowel/bladder incontinence. May require case management to facilitate.
  • Neurosurgery RN calls within 72 hrs after discharge; schedule follow-up during call.
  • Follow-up 4-6 weeks post-op in Neurosurgery Clinic.