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Disparities in indications and outcomes reporting for pediatric tethered cord surgery: The need for a standardized
Matthew C Findlay1,2, Samuel Tenhoeve1, Skyler A Terry3
1School of Medicine, University of Utah, Salt Lake City, UT, USA.
Insights
Tethered cord syndrome (TCS) in children has inconsistent outcome reporting. A standardized measurement tool is needed for better surgical management and research in pediatric TCS.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Disorders
- Surgical Outcomes Research
Background:
- Tethered cord syndrome (TCS) involves abnormal spinal cord attachment, causing diverse symptoms like pain, motor/sensory deficits, and urologic issues.
- While common in children, existing literature shows significant heterogeneity in reporting surgical indications and outcomes.
- This variability hinders effective analysis and comparison of treatment results.
Approach:
- A systematic review of pediatric TCS literature was conducted using PubMed and EMBASE databases.
- Studies published between 1950 and 2023, reporting surgical interventions, follow-up of at least 6 months, and a minimum of 5 patients were included.
- The review focused on identifying and analyzing reported surgical indications and postoperative outcomes.
Key Points:
- Fifty-five studies encompassing 3798 patients were analyzed.
- Commonly reported non-urologic symptoms included motor/sensory disturbances, pain, gait abnormalities, and bowel dysfunction.
- Post-surgery, retethering was a frequent non-urologic outcome, alongside motor deficits, pain, and functional impairments. Urologic outcomes varied, with nonspecific deficits and bladder function changes frequently noted.
Conclusions:
- The current body of literature on pediatric TCS surgical indications and outcomes is highly variable.
- A lack of standardized data elements and consistent quantitative measures impedes higher-level research and comparative analysis.
- Developing and validating a standardized outcomes measurement tool, incorporating patient-reported and objective measures, is crucial for advancing TCS research and surgical care.
Purpose:
Tethered cord syndrome (TCS) is characterized by abnormal attachment of the spinal cord neural elements to surrounding tissues. The most common symptoms include pain, motor or sensory dysfunction, and urologic deficits. Although TCS is common in children, there is a significant heterogeneity in outcomes reporting. We systematically reviewed surgical indications and postoperative outcomes to assess the need for a grading/classification system.
Methods:
PubMed and EMBASE searches identified pediatric TCS literature published between 1950 and 2023. Studies reporting surgical interventions, ≥ 6-month follow-up, and ≥ 5 patients were included.
Results:
Fifty-five studies representing 3798 patients were included. The most commonly reported non-urologic symptoms were nonspecific lower-extremity motor disturbances (36.4% of studies), lower-extremity/back pain (32.7%), nonspecific lower-extremity sensory disturbances (29.1%), gait abnormalities (29.1%), and nonspecific bowel dysfunction/fecal incontinence (25.5%). Urologic symptoms were most commonly reported as nonspecific complaints (40.0%). After detethering surgery, retethering was the most widely reported non-urologic outcome (40.0%), followed by other nonspecific findings: motor deficits (32.7%), lower-extremity/back/perianal pain (18.2%), gait/ambulation function (18.2%), sensory deficits (12.7%), and bowel deficits/fecal incontinence (12.7%). Commonly reported urologic outcomes included nonspecific bladder/urinary deficits (27.3%), bladder capacity (20.0%), bladder compliance (18.2%), urinary incontinence/enuresis/neurogenic bladder (18.2%), and nonspecific urodynamics/urodynamics score change (16.4%).
Conclusion:
TCS surgical literature is highly variable regarding surgical indications and reporting of postsurgical outcomes. The lack of common data elements and consistent quantitative measures inhibits higher-level analysis. The development and validation of a standardized outcomes measurement tool-ideally encompassing both patient-reported outcome and objective measures-would significantly benefit future TCS research and surgical management.
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