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Published on: April 5, 2016
Spinal cord detethering procedures in children: a 5 year retrospective cohort study of the early post-operative
Matthew Thuy1, Raymond Chaseling1, Adam Fowler1
1TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
Insights
Detethering surgery for tethered spinal cord in children is effective in improving neurological and sphincteric issues. Early complications like wound infections were manageable, with no new neurological deficits reported.
Area of Science:
- Pediatric Neurosurgery
- Spinal Surgery
- Pediatric Orthopedics
Background:
- Tethered spinal cord syndrome (TSCS) can lead to significant neurological, orthopedic, and sphincteric dysfunction in children.
- Early surgical intervention through detethering may prevent or reverse these debilitating symptoms.
Purpose of the Study:
- To review the experience of detethering surgery at a major pediatric hospital.
- To examine the early post-operative complications and outcomes of detethering procedures in children.
Main Methods:
- A 5-year retrospective cohort study (2007-2012) of children undergoing detethering surgery.
- Data collected on patient demographics, presenting symptoms, tethering pathologies, surgical procedures, and post-operative complications.
Main Results:
- 63 procedures were performed on 61 children; most common pathologies included spinal lipomas and filum abnormalities.
- The most frequent early complications were wound infection and cerebrospinal fluid leak, with low reoperation rates for these issues.
- No deaths or new neurological deficits occurred; 26.7% of children with preoperative deficits showed improvement, particularly those with motor or sphincteric disturbances.
Conclusions:
- Detethering surgery is a safe and effective procedure for pediatric tethered spinal cord.
- The surgery can lead to significant improvement in neurological and sphincteric function with manageable early complications.
Abstract:
Tethered spinal cord can cause neurological, orthopaedic and sphincteric problems in children and detethering surgery may prevent or reverse these problems. This 5 year retrospective cohort study aimed to review our experience of detethering surgery at The Children's Hospital at Westmead, Sydney, Australia, particularly examining the early post-operative complications of this procedure. Between 2007 and 2012, 61 children underwent 63 detethering procedures. The median age at detethering surgery was 1.4 years old (interquartile range: 0.7-5.6 years). Fifty-five children (90.1%) had lumbosacral procedures, 31 (50.8%) were asymptomatic from tethering, 11 (18.0%) had motor or gait disturbance, 11 (18.0%) sphincteric disturbance, eight (13.1%) lower limb orthopaedic deformities, eight (13.1%) scoliosis, six (9.8%) back or leg pain and two (3.3%) sensory disturbance. The most common tethering pathologies were spinal lipomas in 32 children (52.5%), filum abnormalities in 23 (37.7%), dorsal sinus tracts in eight (13.1%) and diastematomyelia in seven (11.5%). Twenty-six children (42.6%) had either a syrinx or central canal dilatation preoperatively. The most common complications were wound infection and cerebrospinal fluid leak. Six children (9.8%) required reoperation for wound issues and two patients (3.3%) required subsequent reoperation for cord retethering during the study period. There were no deaths and no new neurological deficits. Of the children with the above preoperative deficits, 26.7% were documented to have improvement or resolution of their symptoms post-operatively. The highest rate of improvement occurred in children with motor or gait disturbance (36.4%) or sphincteric disturbance (27.3%).
