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Spinal column shortening for secondary tethered cord syndrome: radiographic, clinical, patient-reported, and urodynamic short-term outcomes
Journal of Neurosurgery: Pediatrics ( IF 1.9 ) Pub Date : 2021-05-07 , DOI: 10.3171/2020.11.peds20847
Luke G. McVeigh 1 , Miracle C. Anokwute 1 , Ahmed Belal 1 , Natasha V. Raman 1 , Kristin Zieles 1 , Konrad M. Szymanski 2 , Rosalia Misseri 2 , Andrew Jea 1, 3
Affiliation  

OBJECTIVE

Tethered cord syndrome (TCS) is a clinical and radiographic diagnosis of pathological stretching of the spinal cord leading to progressive loss of neurological function. The gold standard treatment for TCS is a tethered cord release. However, detethering involves significant risks of spinal cord injury and high rates of retethering. To mitigate these risks, the concept of spinal column shortening (SCS) to decrease spinal cord tension has become an alternative to detethering. In this study, the authors applied SCS to a pediatric and emerging adult population affected by secondary TCS.

METHODS

A retrospective review of a prospective database at the authors’ tertiary pediatric institution was performed. The Pediatric Quality of Life Inventory, patient- and parent-reported outcomes, and urodynamics were used to evaluate the outcomes of TCS treated with SCS.

RESULTS

A total of 41 patients with secondary TCS were treated with SCS. The average age at the time of surgery was 15.9 years (range 5–55 years). Preoperative symptoms evaluated included pain (33 patients), weakness (30 patients), and bladder/bowel dysfunction (39 patients). The most common level of spinal column osteotomy was T12, with spinal fusion between T10 and L2. The mean follow-up time was 22.6 months (range 8–45 months). For patients with at least 12 months of follow-up, subjective clinical improvements were reported in 21/23 (91.3%) of those with preoperative pain (p < 0.01); in 16/24 (66.7%) of patients with weakness (p < 0.01), and in 15/29 (51.7%) of those with bladder/bowel dysfunction (p < 0.01). The median differences in initial and most recent Pediatric Quality of Life Inventory results were +5 for patient-reported scores (n = 19, p = 0.04) and +5 for parent-reported scores (n = 19, p = 0.08). Formal urodynamics performed at a median of 3.5 months after surgery documented stable to improved bladder function in 16/17 patients, with a median improvement in one classification category (n = 17, p = 0.01).

CONCLUSIONS

SCS continues to represent a safe and efficacious alternative to traditional spinal cord untethering for TCS in children and emerging adults, as documented by objective formal urodynamics and patient- and parent-reported outcomes.



中文翻译:

继发性脊髓栓系综合征的脊柱缩短:影像学、临床、患者报告和尿动力学的短期结果

客观的

脊髓栓系综合征 (TCS) 是脊髓病理性拉伸导致神经功能逐渐丧失的临床和放射学诊断。TCS 的黄金标准治疗是绳索释放。然而,束缚涉及脊髓损伤的显着风险和高重新束缚率。为了减轻这些风险,减少脊髓张力的脊柱缩短 (SCS) 概念已成为束缚的替代方法。在这项研究中,作者将 SCS 应用于受继发性 TCS 影响的儿科和新兴成年人群。

方法

对作者所在的三级儿科机构的前瞻性数据库进行了回顾性审查。儿科生活质量量表、患者和家长报告的结果以及尿动力学被用来评估 TCS 用 SCS 治疗的结果。

结果

共有 41 名继发性 TCS 患者接受了 SCS 治疗。手术时的平均年龄为 15.9 岁(范围 5-55 岁)。评估的术前症状包括疼痛(33 名患者)、虚弱(30 名患者)和膀胱/肠功能障碍(39 名患者)。最常见的脊柱截骨水平是 T12,在 T10 和 L2 之间进行脊柱融合。平均随访时间为 22.6 个月(范围 8-45 个月)。对于至少随访 12 个月的患者,有 21/23 (91.3%) 的术前疼痛患者报告了主观临床改善 (p < 0.01);16/24 (66.7%) 的虚弱患者 (p < 0.01) 和 15/29 (51.7%) 的膀胱/肠功能障碍患者 (p < 0.01)。患者报告的分数(n = 19,p = 0.04)和父母报告的分数(n = 19,p = 0.08)的初始和最近的儿科生活质量调查结果的中位数差异为+5。在手术后中位数 3.5 个月进行的正式尿动力学记录表明,16/17 名患者的膀胱功能稳定至改善,其中一个分类类别的中位数改善(n = 17,p = 0.01)。

结论

正如客观的正式尿动力学以及患者和父母报告的结果所证明的那样,SCS 继续代表了一种安全有效的替代传统脊髓解除束缚治疗儿童和新兴成人 TCS 的方法。

更新日期:2021-07-01
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