The aims of this study were to review the National Spina Bifida Patient Registry (NSBPR) data set to study the rates of tethered spinal cord release (TCR) among patients with myelomeningocele and variability between centers, to compare TCR rates between males and females, and to study the relationships between TCR rates and other condition-specific characteristics.

The NSBPR registry was queried to identify all patients with myelomeningocele. TCR rates were calculated over time using survival analyses; rates between centers and between males and females were compared. Cox proportional hazards models were constructed to identify relationships between TCR rates and sex, functional lesion level, ambulation status, treated hydrocephalus, and prior Chiari decompression.

Of 6339 patients with information about their operations, 1366 (21.5%) underwent TCR, with significant variability between centers. The majority (75.8%) underwent a single TCR. The annual TCR rate was linear between birth and 13 years (1.8%/year) but declined sharply from 14 to 21 years (0.7%/year). There was no period of time at which the TCR rate accelerated. There were no significant differences in TCR rates between males and females. TCR rate was not related to functional lesion level but was lower among nonambulators compared with community ambulators (p = 0.005) and among those with treated hydrocephalus (HR 0.30, p < 0.001), and higher among those having prior Chiari decompression (HR 1.71, p < 0.001).

These results extend the results of prior single-institution studies, demonstrate significant treatment variability between institutions, and challenge the traditional concept that tethering is related to spinal cord stretching due to spinal growth.

本研究的目的是审查国家脊柱裂患者登记处 (NSBPR) 数据集，以研究脊髓脊膜膨出患者的脊髓栓系释放 (TCR) 率和中心之间的变异性，比较男性和女性之间的 TCR 率，以及研究 TCR 率与其他条件特定特征之间的关系。

查询 NSBPR 注册表以识别所有脊髓脊膜膨出患者。使用生存分析随时间计算 TCR 率；比较了中心之间以及男女之间的比率。构建 Cox 比例风险模型来确定 TCR 率与性别、功能性病变水平、行走状态、治疗的脑积水和先前的 Chiari 减压之间的关系。

在 6339 名了解其手术信息的患者中，1366 名（21.5%）接受了 TCR，各中心之间存在显着差异。大多数 (75.8%) 经历了一次 TCR。年 TCR 率在出生和 13 岁之间呈线性（1.8%/年），但从 14 岁到 21 岁（0.7%/年）急剧下降。没有一段时间 TCR 速度加快。男性和女性之间的 TCR 率没有显着差异。TCR 率与功能性病变水平无关，但与社区步行者相比，非步行者 (p = 0.005) 和脑积水治疗者 (HR 0.30，p < 0.001) 中的 TCR 率较低，并且在先前接受 Chiari 减压的患者中更高 (HR 1.71， p < 0.001)。

这些结果扩展了先前单一机构研究的结果，证明了机构之间的显着治疗差异，并挑战了传统观念，即束缚与由于脊柱生长导致的脊髓拉伸有关。