Pediatric tethered cord syndrome: Response of scoliosis to untethering procedures

Matthew J. McGirt, Vivek Mehta, Giannina Garces-Ambrossi, Oren Gottfried, C. A N Solakoglu, Ziya L. Gokaslan, Amer Samdani, George Jallo

Research output: Contribution to journalArticle

Abstract

Object. Tethered cord syndrome (TCS) is frequently associated with scoliosis in the pediatric population. Following spinal cord untethering, many patients continue to experience progression of spinal deformity. However, the incidence rate, time course, and risk factors for scoliosis progression following tethered cord release remain unclear. The aim of this study was to determine factors associated with scoliosis progression and whether tethered cord release alone would halt curve progression in pediatric TCS. Methods. The authors retrospectively reviewed 27 consecutive pediatric cases of spinal cord untethering associated with scoliosis. The incidence rate and factors associated with scoliosis progression (> 10°increased Cobb angle) after untethering were evaluated using the Kaplan-Meier method. Results. The mean age of the patients was 8.9 years. All patients underwent cord untethering for lower-extremity weakness, back and leg pain, or bowel and bladder changes. Mean ± SD of the Cobb angle at presentation was 41 ± 16°. The cause of the spinal cord tethering included previous myelomeningocele repair in 14 patients (52%), fatty fi-lum in 5 (18.5%), lipomeningocele in 3 (11%), diastematomyelia in 2 (7.4%), arthrogryposis in 1 (3.7%), imperforate anus with an S-2 hemivertebra in 1 (3.7%), and lipomyelomeningocele with occult dysraphism in 1 (3.7%). Mean follow-up was 6 ± 2 years. Twelve patients (44%) experienced scoliosis progression occurring a median of 2.4 years postoperatively and 8 (30%) required subsequent fusion for progression. At the time of untethering, scoliosis <40° was associated with a 32% incidence of progression, whereas scoliosis > 40° was associated with a 75% incidence of progression (p <0.01). Patients with Risser Grades 0-2 were also more likely to experience scoliosis progression compared with Risser Grades 3-5 (p <0.05). Whereas nearly all patients with Risser Grades 0-2 with curves > 40° showed scoliosis progression (83%), 54% of patients with Risser Grades 0-2 with curves <40° progressed, and no patients with Risser Grades 3-5 with curves <40° progressed following spinal cord untethering. Conclusions. In this experience with pediatric TCS-associated scoliosis, patients with Risser Grades 3-5 and Cobb angles <40° did not experience curve progression after tethered cord release. Patients with Risser Grades 0-2 and Cobb angles > 40° were at greatest risk of curve progression after cord untethering. Pediatric patients with TCSassociated scoliosis should be monitored closely for curve progression using standing radiographs after spinal cord untethering, particularly those with curves > 40° or who have Risser Grades 0-2.

Original languageEnglish (US)
Pages (from-to)270-274
Number of pages5
JournalJournal of Neurosurgery: Pediatrics
Volume4
Issue number3
DOIs
StatePublished - Sep 2009

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Neural Tube Defects
Scoliosis
Pediatrics
Spinal Cord
Incidence
Arthrogryposis
Imperforate Anus
Meningomyelocele
Back Pain
Lower Extremity
Leg
Urinary Bladder

Keywords

  • Outcome
  • Progression
  • Risser grade
  • Scoliosis
  • Stabilization
  • Tethered cord syndrome

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

McGirt, M. J., Mehta, V., Garces-Ambrossi, G., Gottfried, O., Solakoglu, C. A. N., Gokaslan, Z. L., ... Jallo, G. (2009). Pediatric tethered cord syndrome: Response of scoliosis to untethering procedures. Journal of Neurosurgery: Pediatrics, 4(3), 270-274. https://doi.org/10.3171/2009.4.PEDS08463

Pediatric tethered cord syndrome : Response of scoliosis to untethering procedures. / McGirt, Matthew J.; Mehta, Vivek; Garces-Ambrossi, Giannina; Gottfried, Oren; Solakoglu, C. A N; Gokaslan, Ziya L.; Samdani, Amer; Jallo, George.

In: Journal of Neurosurgery: Pediatrics, Vol. 4, No. 3, 09.2009, p. 270-274.

Research output: Contribution to journalArticle

McGirt, MJ, Mehta, V, Garces-Ambrossi, G, Gottfried, O, Solakoglu, CAN, Gokaslan, ZL, Samdani, A & Jallo, G 2009, 'Pediatric tethered cord syndrome: Response of scoliosis to untethering procedures', Journal of Neurosurgery: Pediatrics, vol. 4, no. 3, pp. 270-274. https://doi.org/10.3171/2009.4.PEDS08463
McGirt MJ, Mehta V, Garces-Ambrossi G, Gottfried O, Solakoglu CAN, Gokaslan ZL et al. Pediatric tethered cord syndrome: Response of scoliosis to untethering procedures. Journal of Neurosurgery: Pediatrics. 2009 Sep;4(3):270-274. https://doi.org/10.3171/2009.4.PEDS08463
McGirt, Matthew J. ; Mehta, Vivek ; Garces-Ambrossi, Giannina ; Gottfried, Oren ; Solakoglu, C. A N ; Gokaslan, Ziya L. ; Samdani, Amer ; Jallo, George. / Pediatric tethered cord syndrome : Response of scoliosis to untethering procedures. In: Journal of Neurosurgery: Pediatrics. 2009 ; Vol. 4, No. 3. pp. 270-274.
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title = "Pediatric tethered cord syndrome: Response of scoliosis to untethering procedures",
abstract = "Object. Tethered cord syndrome (TCS) is frequently associated with scoliosis in the pediatric population. Following spinal cord untethering, many patients continue to experience progression of spinal deformity. However, the incidence rate, time course, and risk factors for scoliosis progression following tethered cord release remain unclear. The aim of this study was to determine factors associated with scoliosis progression and whether tethered cord release alone would halt curve progression in pediatric TCS. Methods. The authors retrospectively reviewed 27 consecutive pediatric cases of spinal cord untethering associated with scoliosis. The incidence rate and factors associated with scoliosis progression (> 10°increased Cobb angle) after untethering were evaluated using the Kaplan-Meier method. Results. The mean age of the patients was 8.9 years. All patients underwent cord untethering for lower-extremity weakness, back and leg pain, or bowel and bladder changes. Mean ± SD of the Cobb angle at presentation was 41 ± 16°. The cause of the spinal cord tethering included previous myelomeningocele repair in 14 patients (52{\%}), fatty fi-lum in 5 (18.5{\%}), lipomeningocele in 3 (11{\%}), diastematomyelia in 2 (7.4{\%}), arthrogryposis in 1 (3.7{\%}), imperforate anus with an S-2 hemivertebra in 1 (3.7{\%}), and lipomyelomeningocele with occult dysraphism in 1 (3.7{\%}). Mean follow-up was 6 ± 2 years. Twelve patients (44{\%}) experienced scoliosis progression occurring a median of 2.4 years postoperatively and 8 (30{\%}) required subsequent fusion for progression. At the time of untethering, scoliosis <40° was associated with a 32{\%} incidence of progression, whereas scoliosis > 40° was associated with a 75{\%} incidence of progression (p <0.01). Patients with Risser Grades 0-2 were also more likely to experience scoliosis progression compared with Risser Grades 3-5 (p <0.05). Whereas nearly all patients with Risser Grades 0-2 with curves > 40° showed scoliosis progression (83{\%}), 54{\%} of patients with Risser Grades 0-2 with curves <40° progressed, and no patients with Risser Grades 3-5 with curves <40° progressed following spinal cord untethering. Conclusions. In this experience with pediatric TCS-associated scoliosis, patients with Risser Grades 3-5 and Cobb angles <40° did not experience curve progression after tethered cord release. Patients with Risser Grades 0-2 and Cobb angles > 40° were at greatest risk of curve progression after cord untethering. Pediatric patients with TCSassociated scoliosis should be monitored closely for curve progression using standing radiographs after spinal cord untethering, particularly those with curves > 40° or who have Risser Grades 0-2.",
keywords = "Outcome, Progression, Risser grade, Scoliosis, Stabilization, Tethered cord syndrome",
author = "McGirt, {Matthew J.} and Vivek Mehta and Giannina Garces-Ambrossi and Oren Gottfried and Solakoglu, {C. A N} and Gokaslan, {Ziya L.} and Amer Samdani and George Jallo",
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TY - JOUR

T1 - Pediatric tethered cord syndrome

T2 - Response of scoliosis to untethering procedures

AU - McGirt, Matthew J.

AU - Mehta, Vivek

AU - Garces-Ambrossi, Giannina

AU - Gottfried, Oren

AU - Solakoglu, C. A N

AU - Gokaslan, Ziya L.

AU - Samdani, Amer

AU - Jallo, George

PY - 2009/9

Y1 - 2009/9

N2 - Object. Tethered cord syndrome (TCS) is frequently associated with scoliosis in the pediatric population. Following spinal cord untethering, many patients continue to experience progression of spinal deformity. However, the incidence rate, time course, and risk factors for scoliosis progression following tethered cord release remain unclear. The aim of this study was to determine factors associated with scoliosis progression and whether tethered cord release alone would halt curve progression in pediatric TCS. Methods. The authors retrospectively reviewed 27 consecutive pediatric cases of spinal cord untethering associated with scoliosis. The incidence rate and factors associated with scoliosis progression (> 10°increased Cobb angle) after untethering were evaluated using the Kaplan-Meier method. Results. The mean age of the patients was 8.9 years. All patients underwent cord untethering for lower-extremity weakness, back and leg pain, or bowel and bladder changes. Mean ± SD of the Cobb angle at presentation was 41 ± 16°. The cause of the spinal cord tethering included previous myelomeningocele repair in 14 patients (52%), fatty fi-lum in 5 (18.5%), lipomeningocele in 3 (11%), diastematomyelia in 2 (7.4%), arthrogryposis in 1 (3.7%), imperforate anus with an S-2 hemivertebra in 1 (3.7%), and lipomyelomeningocele with occult dysraphism in 1 (3.7%). Mean follow-up was 6 ± 2 years. Twelve patients (44%) experienced scoliosis progression occurring a median of 2.4 years postoperatively and 8 (30%) required subsequent fusion for progression. At the time of untethering, scoliosis <40° was associated with a 32% incidence of progression, whereas scoliosis > 40° was associated with a 75% incidence of progression (p <0.01). Patients with Risser Grades 0-2 were also more likely to experience scoliosis progression compared with Risser Grades 3-5 (p <0.05). Whereas nearly all patients with Risser Grades 0-2 with curves > 40° showed scoliosis progression (83%), 54% of patients with Risser Grades 0-2 with curves <40° progressed, and no patients with Risser Grades 3-5 with curves <40° progressed following spinal cord untethering. Conclusions. In this experience with pediatric TCS-associated scoliosis, patients with Risser Grades 3-5 and Cobb angles <40° did not experience curve progression after tethered cord release. Patients with Risser Grades 0-2 and Cobb angles > 40° were at greatest risk of curve progression after cord untethering. Pediatric patients with TCSassociated scoliosis should be monitored closely for curve progression using standing radiographs after spinal cord untethering, particularly those with curves > 40° or who have Risser Grades 0-2.

AB - Object. Tethered cord syndrome (TCS) is frequently associated with scoliosis in the pediatric population. Following spinal cord untethering, many patients continue to experience progression of spinal deformity. However, the incidence rate, time course, and risk factors for scoliosis progression following tethered cord release remain unclear. The aim of this study was to determine factors associated with scoliosis progression and whether tethered cord release alone would halt curve progression in pediatric TCS. Methods. The authors retrospectively reviewed 27 consecutive pediatric cases of spinal cord untethering associated with scoliosis. The incidence rate and factors associated with scoliosis progression (> 10°increased Cobb angle) after untethering were evaluated using the Kaplan-Meier method. Results. The mean age of the patients was 8.9 years. All patients underwent cord untethering for lower-extremity weakness, back and leg pain, or bowel and bladder changes. Mean ± SD of the Cobb angle at presentation was 41 ± 16°. The cause of the spinal cord tethering included previous myelomeningocele repair in 14 patients (52%), fatty fi-lum in 5 (18.5%), lipomeningocele in 3 (11%), diastematomyelia in 2 (7.4%), arthrogryposis in 1 (3.7%), imperforate anus with an S-2 hemivertebra in 1 (3.7%), and lipomyelomeningocele with occult dysraphism in 1 (3.7%). Mean follow-up was 6 ± 2 years. Twelve patients (44%) experienced scoliosis progression occurring a median of 2.4 years postoperatively and 8 (30%) required subsequent fusion for progression. At the time of untethering, scoliosis <40° was associated with a 32% incidence of progression, whereas scoliosis > 40° was associated with a 75% incidence of progression (p <0.01). Patients with Risser Grades 0-2 were also more likely to experience scoliosis progression compared with Risser Grades 3-5 (p <0.05). Whereas nearly all patients with Risser Grades 0-2 with curves > 40° showed scoliosis progression (83%), 54% of patients with Risser Grades 0-2 with curves <40° progressed, and no patients with Risser Grades 3-5 with curves <40° progressed following spinal cord untethering. Conclusions. In this experience with pediatric TCS-associated scoliosis, patients with Risser Grades 3-5 and Cobb angles <40° did not experience curve progression after tethered cord release. Patients with Risser Grades 0-2 and Cobb angles > 40° were at greatest risk of curve progression after cord untethering. Pediatric patients with TCSassociated scoliosis should be monitored closely for curve progression using standing radiographs after spinal cord untethering, particularly those with curves > 40° or who have Risser Grades 0-2.

KW - Outcome

KW - Progression

KW - Risser grade

KW - Scoliosis

KW - Stabilization

KW - Tethered cord syndrome

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