Association Between Age and Outcomes for Children Undergoing Tethered Cord Release: A National Study

The optimal timing of tethered cord release (TCR) for the treatment of tethered cord syndrome (TCS) is controversial, especially among asymptomatic children. The aim of this study was to compare short- and long-term outcomes after TCR across pediatric age groups.

This is a multicenter national retrospective cohort analysis of the Kids Inpatient Database (KID) and Nationwide Readmissions Database between 2016 and 2022 to examine peri- and postoperative outcomes, respectively. Pediatric patients (<18 years) with primary TCS undergoing elective TCR were identified. Patients with secondary TCS or concomitant spinal cord anomalies were excluded. Subjects were stratified into infants (<1 year old), toddlers (1-2 years), and preschool+ children (3-17 years). Perioperative outcomes including discharge destination, complications, and postoperative outcomes including nonelective readmissions, and composite peri- and post-operative complications up to 180 days were evaluated using time-to-event analyses.

A total of 6821 children met inclusion criteria: 1628 (28.9%) were infants, 1619 (23.7%) were toddlers, and 3574 (52.4%) were preschool+ children. The majority (76.8%) were asymptomatic at surgery, with the proportion of symptomatic patients increasing with age ( P < .001). Perioperative complication rates were low (5.5%) and did not differ between age groups (adjusted P -value = .6). Infants and toddlers experienced a significantly higher risk of nonelective readmission compared with preschool+ children within 180 days postdischarge (hazard ratio 1.59 [95% CI: 1.06-2.40], P = .027 and 1.50 [95% CI: 1.01-2.22], P = .046, respectively). Within 180 days, infants were also significantly more likely to experience peri- and postoperative complications than the preschool+ group (hazard ratio 1.56 [95% CI 1.14-2.13], P = .006).

TCR is associated with a low perioperative complication rate. However, infants undergoing TCR are at an increased risk of long-term complications and readmission compared with older children. These findings suggest careful patient selection and consideration of delayed intervention until after the age of 1 year for asymptomatic children.