Spinal column shortening for secondary tethered cord syndrome: radiographic, clinical, patient-reported, and urodynamic short-term outcomes

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  • 1 Section of Pediatric Neurosurgery, Department of Neurological Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis;
  • | 2 Section of Pediatric Urology, Department of Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana; and
  • | 3 Division of Pediatric Neurosurgery, Department of Neurosurgery, Oklahoma Children’s Hospital, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
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OBJECTIVE

Tethered cord syndrome (TCS) is a clinical and radiographic diagnosis of pathological stretching of the spinal cord leading to progressive loss of neurological function. The gold standard treatment for TCS is a tethered cord release. However, detethering involves significant risks of spinal cord injury and high rates of retethering. To mitigate these risks, the concept of spinal column shortening (SCS) to decrease spinal cord tension has become an alternative to detethering. In this study, the authors applied SCS to a pediatric and emerging adult population affected by secondary TCS.

METHODS

A retrospective review of a prospective database at the authors’ tertiary pediatric institution was performed. The Pediatric Quality of Life Inventory, patient- and parent-reported outcomes, and urodynamics were used to evaluate the outcomes of TCS treated with SCS.

RESULTS

A total of 41 patients with secondary TCS were treated with SCS. The average age at the time of surgery was 15.9 years (range 5–55 years). Preoperative symptoms evaluated included pain (33 patients), weakness (30 patients), and bladder/bowel dysfunction (39 patients). The most common level of spinal column osteotomy was T12, with spinal fusion between T10 and L2. The mean follow-up time was 22.6 months (range 8–45 months). For patients with at least 12 months of follow-up, subjective clinical improvements were reported in 21/23 (91.3%) of those with preoperative pain (p < 0.01); in 16/24 (66.7%) of patients with weakness (p < 0.01), and in 15/29 (51.7%) of those with bladder/bowel dysfunction (p < 0.01). The median differences in initial and most recent Pediatric Quality of Life Inventory results were +5 for patient-reported scores (n = 19, p = 0.04) and +5 for parent-reported scores (n = 19, p = 0.08). Formal urodynamics performed at a median of 3.5 months after surgery documented stable to improved bladder function in 16/17 patients, with a median improvement in one classification category (n = 17, p = 0.01).

CONCLUSIONS

SCS continues to represent a safe and efficacious alternative to traditional spinal cord untethering for TCS in children and emerging adults, as documented by objective formal urodynamics and patient- and parent-reported outcomes.

ABBREVIATIONS

BMP = bone morphogenetic protein; EBL = estimated blood loss; MCID = minimum clinically important difference; PedsQL = Pediatric Quality of Life Inventory; SCS = spinal column shortening; TCR = tethered cord release; TCS = tethered cord syndrome; UTI = urinary tract infection.
Images from Szuflita et al. (pp 28–33).

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Contributor Notes

Correspondence Andrew Jea: Oklahoma Children’s Hospital, Oklahoma City, OK. andrew-jea@ouhsc.edu.

ACCOMPANYING EDITORIAL DOI: 10.3171/2020.12.PEDS20925.

INCLUDE WHEN CITING Published online May 7, 2021; DOI: 10.3171/2020.11.PEDS20847.

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

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