TY - JOUR
T1 - Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome
T2 - A Multicenter, Retrospective Analysis
AU - Theodore, Nicholas
AU - Cottrill, Ethan
AU - Kalb, Samuel
AU - Zygourakis, Corinna
AU - Jiang, Bowen
AU - Pennington, Zach
AU - Lubelski, Daniel
AU - Westbroek, Erick M.
AU - Ahmed, A. Karim
AU - Ehresman, Jeff
AU - Sciubba, Daniel M.
AU - Witham, Timothy F.
AU - Turner, Jay D.
AU - Groves, Mari
AU - Kakarla, U. Kumar
N1 - Publisher Copyright:
© 2020 Congress of Neurological Surgeons 2020.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - BACKGROUND: Few have explored the safety and efficacy of posterior vertebral column subtraction osteotomy (PVCSO) to treat tethered cord syndrome (TCS). OBJECTIVE: To evaluate surgical outcomes after PVCSO in adults with TCS caused by lipomyelomeningocele, who had undergone a previous detethering procedure(s) that ultimately failed. METHODS: This is a multicenter, retrospective analysis of a prospectively collected cohort. Patients were prospectively enrolled and treated with PVCSO at 2 institutions between January 1, 2011 and December 31, 2018. Inclusion criteria were age ≥18 yr, TCS caused by lipomyelomeningocele, previous detethering surgery, and recurrent symptom progression of less than 2-yr duration. All patients undergoing surgery with a 1-yr minimum follow-up were evaluated. RESULTS: A total of 20 patients (mean age: 36 yr; sex: 15F/5M) met inclusion criteria and were evaluated. At follow-up (mean: 23.3 ± 7.4 mo), symptomatic improvement/resolution was seen in 93% of patients with leg pain, 84% in back pain, 80% in sensory abnormalities, 80% in motor deficits, 55% in bowel incontinence, and 50% in urinary incontinence. Oswestry Disability Index improved from a preoperative mean of 57.7 to 36.6 at last follow-up (P <. 01). Mean spinal column height reduction was 23.4 ± 2.7 mm. Four complications occurred: intraoperative durotomy (no reoperation), wound infection, instrumentation failure requiring revision, and new sensory abnormality. CONCLUSION: This is the largest study to date assessing the safety and efficacy of PVCSO in adults with TCS caused by lipomyelomeningocele and prior failed detethering. We found PVCSO to be an excellent extradural approach that may afford definitive treatment in this particularly challenging population.
AB - BACKGROUND: Few have explored the safety and efficacy of posterior vertebral column subtraction osteotomy (PVCSO) to treat tethered cord syndrome (TCS). OBJECTIVE: To evaluate surgical outcomes after PVCSO in adults with TCS caused by lipomyelomeningocele, who had undergone a previous detethering procedure(s) that ultimately failed. METHODS: This is a multicenter, retrospective analysis of a prospectively collected cohort. Patients were prospectively enrolled and treated with PVCSO at 2 institutions between January 1, 2011 and December 31, 2018. Inclusion criteria were age ≥18 yr, TCS caused by lipomyelomeningocele, previous detethering surgery, and recurrent symptom progression of less than 2-yr duration. All patients undergoing surgery with a 1-yr minimum follow-up were evaluated. RESULTS: A total of 20 patients (mean age: 36 yr; sex: 15F/5M) met inclusion criteria and were evaluated. At follow-up (mean: 23.3 ± 7.4 mo), symptomatic improvement/resolution was seen in 93% of patients with leg pain, 84% in back pain, 80% in sensory abnormalities, 80% in motor deficits, 55% in bowel incontinence, and 50% in urinary incontinence. Oswestry Disability Index improved from a preoperative mean of 57.7 to 36.6 at last follow-up (P <. 01). Mean spinal column height reduction was 23.4 ± 2.7 mm. Four complications occurred: intraoperative durotomy (no reoperation), wound infection, instrumentation failure requiring revision, and new sensory abnormality. CONCLUSION: This is the largest study to date assessing the safety and efficacy of PVCSO in adults with TCS caused by lipomyelomeningocele and prior failed detethering. We found PVCSO to be an excellent extradural approach that may afford definitive treatment in this particularly challenging population.
KW - Detethering
KW - Lipomyelomeningocele
KW - Posterior vertebral column subtraction osteotomy
KW - Tethered cord syndrome
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U2 - 10.1093/neuros/nyaa491
DO - 10.1093/neuros/nyaa491
M3 - Article
C2 - 33372221
AN - SCOPUS:85102153358
SN - 0148-396X
VL - 88
SP - 637
EP - 647
JO - Neurosurgery
JF - Neurosurgery
IS - 3
ER -