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.

中文翻译：

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复发性脊髓栓系综合征的后脊柱减法截骨术：一项多中心、回顾性分析

背景 很少有人探讨后路脊柱减影截骨术 (PVCSO) 治疗脊髓栓系综合征 (TCS) 的安全性和有效性。目的 评估由脂肪脊髓脊膜膨出引起的 TCS 成人患者进行 PVCSO 后的手术结果，这些患者之前曾接受过最终失败的解栓程序。方法 这是对前瞻性收集队列的多中心回顾性分析。患者在 2011 年 1 月 1 日至 2018 年 12 月 31 日期间在 2 家机构进行了前瞻性招募和 PVCSO 治疗。纳入标准为年龄≥18 岁、由脂肪脊髓脊膜膨出引起的 TCS、既往脱栓手术、以及持续时间少于 2 年的复发性症状进展. 对所有接受手术且至少随访 1 年的患者进行评估。结果 共有 20 名患者（平均年龄：36 岁；性别：15F/5M) 符合纳入标准并进行了评估。随访时（平均：23.3 ± 7.4 个月），93% 的腿痛患者症状改善/消退，84% 的背痛患者，80% 的感觉异常患者，80% 的运动障碍患者，55% 的肠道患者尿失禁，50% 为尿失禁。Oswestry 残疾指数从术前平均值 57.7 提高到最后一次随访时的 36.6 (P < .01)。平均脊柱高度减少 23.4 ± 2.7 毫米。发生了四种并发症：术中硬脑膜切开术（无需再次手术）、伤口感染、需要翻修的器械故障和新的感觉异常。结论 这是迄今为止最大的一项研究，评估了 PVCSO 对由脂肪脊髓脊膜膨出和先前的束缚失败引起的 TCS 成人患者的安全性和有效性。