Spinal column shortening versus revision detethering for recurrent adult tethered cord syndrome: a preliminary comparison of perioperative and clinical outcomes

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  • 1 Department of Neurosurgery, University of California, San Francisco, California;
  • 2 Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China;
  • 3 Department of Neurosurgery, Taipei Veterans General Hospital, Taipei; and
  • 4 School of Medicine, National Yang-Ming University, Taipei, Taiwan
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OBJECTIVE

Recurrent tethered cord syndrome (TCS), believed to result from tension on the distal portion of the spinal cord, causes a constellation of neurological symptoms. Detethering surgery has been the traditional treatment for TCS. However, in cases of recurrent TCS, there is a risk of new neurological deficits developing, and subsequent retethering is difficult to prevent. Spinal column shortening has been proposed as an alternative technique to reduce the tension on the spinal cord without incurring the morbidity of revision surgery on the spinal cord. The authors compared the perioperative outcomes and morbidity of patients who were treated with one or the other procedure.

METHODS

The medical records of 16 adult patients with recurrent TCS who were treated between 2005 and 2018 were reviewed. Eight patients underwent spinal column shortening, and 8 patients underwent revision detethering surgery. Patient demographics, clinical outcomes, and perioperative factors were analyzed. The authors include a video to illustrate their technique of spinal column shortening.

RESULTS

Within the spinal column shortening group, no patients experienced any complications, and all 8 patients either improved or stabilized with regard to lower-extremity and bowel and bladder function. Within the revision detethering group, 2 patients had worsening of lower-extremity strength, 3 patients had worsening of bowel and bladder function, and 1 patient had improvement in bladder function. Also, 3 patients had wound-related complications. The median estimated blood loss was 731 ml in the shortening group and 163 ml in the revision detethering group. The median operative time was 358 minutes in the shortening group and 226 minutes in the revision detethering group.

CONCLUSIONS

Clinical outcomes were comparable between the groups, but none of the spinal column shortening patients experienced worsening, whereas 3 of the revision detethering patients did and also had wound-related complications. Although the operative times and blood loss were higher in the spinal column shortening group, this procedure may be an alternative to revision detethering in extremely scarred or complex wound revision cases.

ABBREVIATIONS EBL = estimated blood loss; PSO = pedicle subtraction osteotomy; TCS = tethered cord syndrome; UCSF = University of California, San Francisco; VAS = visual analog scale.

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Contributor Notes

Correspondence Dean Chou: University of California, San Francisco, CA. dean.chou@ucsf.edu.

INCLUDE WHEN CITING Published online February 7, 2020; DOI: 10.3171/2019.12.SPINE19659.

C.Z. and C.C.C. contributed equally to this work.

Disclosures Dr. Mummaneni: consultant for DePuy Synthes, Globus, and Stryker; direct stock ownership in Spinicity/ISD; support of non–study-related clinical or research effort from NREF, AOSpine, and ISSG; royalties from DePuy Synthes, Thieme Publishers, and Springer Publishers; and honoraria from Spineart. Dr. Dhall: consultant for DePuy Synthes and Globus Medical. Dr. Chou: consultant for Medtronic and Globus and royalties from Globus.

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