Tethered spinal cord among individuals with myelomeningocele: an analysis of the National Spina Bifida Patient Registry

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  • 1 Department of Neurosurgery, Penn State Hershey Children’s Hospital and Penn State College of Medicine, Hershey;
  • | 2 Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania;
  • | 3 Department of Neurosurgery, Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern University College of Medicine, Chicago, Illinois;
  • | 4 Department of Neurosurgery, Gillette Children’s Specialty Healthcare, St. Paul, Minnesota;
  • | 5 Department of Neurosurgery, Children’s of Alabama and University of Alabama at Birmingham, Alabama;
  • | 6 Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon; and
  • | 7 Departments of Neurosurgery and
  • | 8 Developmental Behavioral Pediatrics, Seattle Children’s Hospital and University of Washington College of Medicine, Seattle, Washington
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OBJECTIVE

The aims of this study were to review the National Spina Bifida Patient Registry (NSBPR) data set to study the rates of tethered spinal cord release (TCR) among patients with myelomeningocele and variability between centers, to compare TCR rates between males and females, and to study the relationships between TCR rates and other condition-specific characteristics.

METHODS

The NSBPR registry was queried to identify all patients with myelomeningocele. TCR rates were calculated over time using survival analyses; rates between centers and between males and females were compared. Cox proportional hazards models were constructed to identify relationships between TCR rates and sex, functional lesion level, ambulation status, treated hydrocephalus, and prior Chiari decompression.

RESULTS

Of 6339 patients with information about their operations, 1366 (21.5%) underwent TCR, with significant variability between centers. The majority (75.8%) underwent a single TCR. The annual TCR rate was linear between birth and 13 years (1.8%/year) but declined sharply from 14 to 21 years (0.7%/year). There was no period of time at which the TCR rate accelerated. There were no significant differences in TCR rates between males and females. TCR rate was not related to functional lesion level but was lower among nonambulators compared with community ambulators (p = 0.005) and among those with treated hydrocephalus (HR 0.30, p < 0.001), and higher among those having prior Chiari decompression (HR 1.71, p < 0.001).

CONCLUSIONS

These results extend the results of prior single-institution studies, demonstrate significant treatment variability between institutions, and challenge the traditional concept that tethering is related to spinal cord stretching due to spinal growth.

ABBREVIATIONS

MMC = myelomeningocele; NSBPR = National Spina Bifida Patient Registry; TCR = tethered cord release.

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Contributor Notes

Correspondence Mark S. Dias: Penn State Health Hershey Children’s Hospital, Hershey, PA. mdias@pennstatehealth.psu.edu.

INCLUDE WHEN CITING Published online May 7, 2021; DOI: 10.3171/2020.12.PEDS20868.

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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