Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis

Nicholas Theodore, Ethan Cottrill, Samuel Kalb, Corinna Zygourakis, Bowen Jiang, Zach Pennington, Daniel Lubelski, Erick M. Westbroek, A. Karim Ahmed, Jeff Ehresman, Daniel M. Sciubba, Timothy F. Witham, Jay D. Turner, Mari Groves, U. Kumar Kakarla

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)637-647
Number of pages11
JournalNeurosurgery
Volume88
Issue number3
DOIs
StatePublished - Mar 1 2021
Externally publishedYes

Keywords

  • Detethering
  • Lipomyelomeningocele
  • Posterior vertebral column subtraction osteotomy
  • Tethered cord syndrome

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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