Prophylactic Spinal Cord Untethering in Children with Spinal Dysraphism Undergoing Thoracolumbar Fusion for Scoliosis

Area of Science:

• Pediatric Orthopedics
• Neurosurgery
• Spinal Surgery

Background:

• Children with myelomeningocele and spinal dysraphism often develop scoliosis requiring surgical intervention.
• The necessity of prophylactic spinal cord untethering during thoracolumbar fusion for scoliosis in this population remains unclear.
• Potential neurologic decline is a concern in these complex cases.

Purpose of the Study:

• To evaluate the neurologic and functional outcomes of children with spinal dysraphism who underwent spinal fusion for scoliosis.
• To compare outcomes between patients who had prophylactic spinal cord untethering and those who did not.

Main Methods:

• Retrospective, single-center review of 17 patients with spinal dysraphism undergoing thoracolumbar fusion for scoliosis between 2009 and 2019.
• Patients were analyzed based on whether they received prophylactic spinal cord untethering (8/17) or not.
• Outcomes assessed included changes in Cobb angle, ambulatory status, and neurological function (motor/sensory evoked potentials, motor level).

Main Results:

• No significant difference in the change of Cobb angle between the untethered (19.4°) and non-untethered (19.9°) groups.
• Similar ambulatory status between groups: 37% in the untethered group and 44% in the non-untethered group were community or household ambulators.
• No intraoperative changes in motor or sensory evoked potentials, and no patient experienced a change in motor level or ambulatory status post-surgery.

Conclusions:

• Prophylactic spinal cord untethering may not be necessary for children with spinal dysraphism undergoing thoracolumbar fusion for moderate scoliosis.
• The study's small sample size limits definitive conclusions.
• Larger registry data reviews are recommended to confirm the necessity of prophylactic spinal cord untethering in this patient population.