Introduction: Tethered cord syndrome (TCS) is the clinical manifestation of an abnormal stretch on the spinal cord and the direct untethering is considered its standard treatment. However it carries potential complications as new neurological deficits, cerebrospinal fluid leak or retethering. To avoid these risks, we applied spinal column shortening (SCS) to patients with primary and secondary TCS and report treatment outcomes. The aim of this study was to determine the safety and efficacy of SCS for tethered cord syndrome by analyzing our experience with this surgical technique.
Methods: We retrospectively reviewed the demographic and procedural data of children and transitional adults who had undergone SCS for primary or secondary TCS
Results: Eight patients with TCS caused by myelomeningocele, lipomyelomeningocele, and transitional spinal lipoma were treated with SCS. One patient with less than 24 months of follow-up was excluded. There were three males and four females; average age at the time was surgery was 16 years. Clinical presentations for our patients included pain (5 patients), weakness (4 patients), and bowel/bladder dysfunction (4 patients). Spinal column osteotomy was most commonly performed at the L1 level, with fusion between T12-L2 using a pedicle screw-rod construct. Pedicle subtraction osteotomy (PSO) was applied in six patients; Vertebral column resection (VCR) was applied in one patient. The average follow-up period was 31 months. Computed tomography–based radiographic outcomes showed solid fusion and no instrumentation failure in all cases by the most recent follow-up. Five of seven patients (71%) reported improvement in preoperative symptoms. The mean differences in initial and most recent SRS-22 and Oswestry Disability Index (ODI) scores were 0.26 and -13%, respectively; minimum clinically important difference (MCID) in SRS-22 and ODI were assumed to be 0.4 and -12.8%, respectively.
Conclusions: SCS seems to represent a safe and efficacious alternative to traditional untethering of the spinal cord for TCS.
Patient Care: For first time, we offer the SCS as first alternative for primary TCS, discussing our report treatment outcomes in these patients. An option for the TCS where only the untethering has been considered previously as a choice. Introduce alternatives with good outcomes in the treatment of such complex syndrome is always an improvement in the patient care.
The work has been submitted as a Manuscript in Neurosurgery. It is under revision at this point.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the technique of SCS
2) Discuss the alternatives in the treatment of the TCS
3) Identify those patients where the SCS could be offered as first choice of treatment.
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