Intradural spine surgery may not carry an increased risk of shunt revision compared with extradural spine surgery in pediatric patients with myelomeningocele

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OBJECTIVE

Patients with myelomeningocele are often affected by scoliosis and tethered cord syndrome, and frequently require spine surgery. Intradural spine surgeries may carry an inherently higher risk of inducing shunt malfunction due to entry into the subarachnoid space. In this study, the authors sought to compare rates of shunt malfunction after intradural and extradural spine surgeries among pediatric patients with myelomeningocele.

METHODS

The authors reviewed records of the National Spina Bifida Program Registry for Children’s Hospital of Alabama. The Exago reporting function was used to identify patients who had received at least one of the following procedures: shunt revision, tethered cord release (TCR), or spinal fusion for deformity. The registry records were reviewed for all identified patients to determine if a shunt revision was performed within the 1st year after TCR or spinal fusion.

RESULTS

Final analyses included 117 patients, of whom 39 underwent spinal fusion and 78 underwent TCR. Among patients who underwent spinal fusion, shunt revision was performed within 30 days in 2 patients (5.1%), within 60 days in 2 (5.1%), within 90 days in 4 (10.3%), and within 1 year in 5 (12.8%). Among patients who underwent TCR, shunt revision was performed within 30 days in 7 patients (9.0%), within 60 days in 10 (12.8%), within 90 days in 11 (14.1%), and within 1 year in 17 (21.8%). Using the log-rank test, there was no significant difference in Kaplan-Meier curves between intradural and extradural groups (p = 0.59).

CONCLUSIONS

In a review of single-institution registry data, the authors found no statistically significant difference in the risk of shunt malfunction after intradural and extradural spine surgeries.

ABBREVIATIONS EMR = electronic medical record; IQR = interquartile range; MMC = myelomeningocele; NSBPR = National Spina Bifida Program Registry; T/A = tonsillectomy and/or adenoidectomy; TCR = tethered cord release.

Article Information

Correspondence Elizabeth Kuhn, Department of Neurosurgery, University of Alabama, 1720 2nd Ave. South, FOT 1057, Birmingham, AL 35294. email: ekuhn@uabmc.edu.

INCLUDE WHEN CITING Published online October 20, 2017; DOI: 10.3171/2017.7.PEDS17274.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Bar graph showing comparison of shunt revision rates after spinal fusion and TCR. Values on the y-axis denote percentages. Figure is available in color online only.

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    Kaplan-Meier curve depicting freedom from shunt revision. Figure is available in color online only.

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