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

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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.
Article Information

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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References
  • 1

    Agarwalla PKDunn IFScott RMSmith ER: Tethered cord syndrome. Neurosurg Clin N Am 18:5315472007

  • 2

    Aldave GHansen DHwang SWMoreno ABriceño VJea A: Spinal column shortening for tethered cord syndrome associated with myelomeningocele, lumbosacral lipoma, and lipomyelomeningocele in children and young adults. J Neurosurg Pediatr 19:7037102017

    • Search Google Scholar
    • Export Citation
  • 3

    Bui CJTubbs RSOakes WJ: Tethered cord syndrome in children: a review. Neurosurg Focus 23(2):E22007

  • 4

    Grande AWMaher PCMorgan CJChoutka OLing BCRaderstorf TC: Vertebral column subtraction osteotomy for recurrent tethered cord syndrome in adults: a cadaveric study. J Neurosurg Spine 4:4784842006

    • Search Google Scholar
    • Export Citation
  • 5

    Hou YSun JShi JGuo YWang YShi G: Clinical evaluation of an innovative operative procedure in the treatment of the tethered cord syndrome. Spine J 18:99810042018

    • Search Google Scholar
    • Export Citation
  • 6

    Hsieh PCOndra SLGrande AWO’Shaughnessy BABierbrauer KCrone KR: Posterior vertebral column subtraction osteotomy: a novel surgical approach for the treatment of multiple recurrences of tethered cord syndrome. J Neurosurg Spine 10:2782862009

    • Search Google Scholar
    • Export Citation
  • 7

    Hsieh PCStapleton CJMoldavskiy PKoski TROndra SLGokaslan ZL: Posterior vertebral column subtraction osteotomy for the treatment of tethered cord syndrome: review of the literature and clinical outcomes of all cases reported to date. Neurosurg Focus 29(1):E62010

    • Search Google Scholar
    • Export Citation
  • 8

    Huang SLPeng JYuan GLDing XYHe XJLan BS: A new model of tethered cord syndrome produced by slow traction. Sci Rep 5:91162015

    • Search Google Scholar
    • Export Citation
  • 9

    Iskandar BJFulmer BBHadley MNOakes WJ: Congenital tethered spinal cord syndrome in adults. Neurosurg Focus 10(1):e72001

  • 10

    Kang JKYoon KJHa SSLee IWJeun SSKang SG: Surgical management and outcome of tethered cord syndrome in school-aged children, adolescents, and young adults. J Korean Neurosurg Soc 46:4684712009

    • Search Google Scholar
    • Export Citation
  • 11

    Kanno HAizawa TOzawa HHoshikawa TItoi EKokubun S: Spine-shortening vertebral osteotomy in a patient with tethered cord syndrome and a vertebral fracture. Case report. J Neurosurg Spine 9:62662008

    • Search Google Scholar
    • Export Citation
  • 12

    Kawamura IIshido YZenmyo MYamamoto TKagawa YKomiya S: Pedicle subtraction osteotomy for adult tethered cord syndrome with lumbar canal stenosis: report of two cases. Int J Neurosci 120:7357372010

    • Search Google Scholar
    • Export Citation
  • 13

    Klekamp J: Tethered cord syndrome in adults. J Neurosurg Spine 15:2582702011

  • 14

    Kokubun SOzawa HAizawa TLy NMTanaka Y: Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. J Neurosurg Spine 15:21272011

    • Search Google Scholar
    • Export Citation
  • 15

    Lee GYParadiso GTator CHGentili FMassicotte EMFehlings MG: Surgical management of tethered cord syndrome in adults: indications, techniques, and long-term outcomes in 60 patients. J Neurosurg Spine 4:1231312006

    • Search Google Scholar
    • Export Citation
  • 16

    Lew SMKothbauer KF: Tethered cord syndrome: an updated review. Pediatr Neurosurg 43:2362482007

  • 17

    Maroun FBJacob JCMurray GP: Tethered cord syndrome in adults. Surg Neurol 54:4032000

  • 18

    Miyakoshi NAbe ESuzuki TKido TChiba MShimada Y: Spine-shortening vertebral osteotomy for tethered cord syndrome: report of three cases. Spine (Phila Pa 1976) 34:E823E8252009

    • Search Google Scholar
    • Export Citation
  • 19

    Nakashima HImagama SMatsui HYukawa YSato KKanemura T: Comparative study of untethering and spine-shortening surgery for tethered cord syndrome in adults. Global Spine J 6:5355412016

    • Search Google Scholar
    • Export Citation
  • 20

    Romagna ASuchorska BSchwartz CTonn JCZausinger S: Detethering of a congenital tethered cord in adult patients: an outcome analysis. Acta Neurochir (Wien) 155:7938002013

    • Search Google Scholar
    • Export Citation
  • 21

    Safaee MMWinkler EAChou D: Mini-open spinal column shortening for the treatment of adult tethered cord syndrome. J Clin Neurosci 44:3153192017

    • Search Google Scholar
    • Export Citation
  • 22

    Schneider SJRosenthal ADGreenberg BMDanto J: A preliminary report on the use of laser-Doppler flowmetry during tethered spinal cord release. Neurosurgery 32:2142181993

    • Search Google Scholar
    • Export Citation
  • 23

    Seki THida KYano SHoukin K: Surgical outcomes of pediatric patients with asymptomatic tethered cord syndrome. Asian Spine J 12:5515552018

    • Search Google Scholar
    • Export Citation
  • 24

    Selcuki MMete MBarutcuoglu MDuransoy YKUmur ASSelcuki D: Tethered cord syndrome in adults: experience of 56 patients. Turk Neurosurg 25:9229292015

    • Search Google Scholar
    • Export Citation
  • 25

    Shih PHalpin RJGanju ALiu JCKoski TR: Management of recurrent adult tethered cord syndrome. Neurosurg Focus 29(1):E52010

  • 26

    Sofuoglu OEAbdallah AEmel EOfluoglu AEGunes MGuler B: Management of tethered cord syndrome in adults: experience of 23 cases. Turk Neurosurg 27:2262362017

    • Search Google Scholar
    • Export Citation
  • 27

    Steinbok PMacNeily AE: Section of the terminal filum for occult tethered cord syndrome: toward a scientific answer. Neurosurg Focus 23(2):E52007

    • Search Google Scholar
    • Export Citation
  • 28

    Wang HSun JWang YWu ZXu TChen K: [Homogeneous spinal-shortening axial decompression procedure for tethered cord syndrome.] Zhonghua Yi Xue Za Zhi 95:180118062015 (Chinese)

    • Search Google Scholar
    • Export Citation
  • 29

    Yamada S: Tethered cord syndrome in adults and children. Neurol Res 26:7177182004

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