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Spinal column shortening for tethered cord syndrome associated with myelomeningocele, lumbosacral lipoma, and lipomyelomeningocele in children and young adults.
- Source :
-
Journal of neurosurgery. Pediatrics [J Neurosurg Pediatr] 2017 Jun; Vol. 19 (6), pp. 703-710. Date of Electronic Publication: 2017 Mar 31. - Publication Year :
- 2017
-
Abstract
- OBJECTIVE Tethered cord syndrome is the clinical manifestation of an abnormal stretch on the spinal cord, presumably causing mechanical injury, a compromised blood supply, and altered spinal cord metabolism. Tethered cord release is the standard treatment for tethered cord syndrome. However, direct untethering of the spinal cord carries potential risks, such as new neurological deficits from spinal cord injury, a CSF leak from opening the dura, and retethering of the spinal cord from normal scar formation after surgery. To avoid these risks, the authors applied spinal column shortening to children and transitional adults with primary and secondary tethered cord syndrome and report treatment outcomes. The authors' aim with this study was to determine the safety and efficacy of spinal column shortening for tethered cord syndrome by analyzing their experience with this surgical technique. METHODS The authors retrospectively reviewed the demographic and procedural data of children and young adults who had undergone spinal column shortening for primary or secondary tethered cord syndrome. RESULTS Seven patients with tethered cord syndrome caused by myelomeningocele, lipomyelomeningocele, and transitional spinal lipoma were treated with spinal column shortening. One patient with less than 24 months of follow-up was excluded from further analysis. There were 3 males and 4 females; the average age at the time was surgery was 16 years (range 8-30 years). Clinical presentations for our patients included pain (in 5 patients), weakness (in 4 patients), and bowel/bladder dysfunction (in 4 patients). Spinal column osteotomy was most commonly performed at the L-1 level, with fusion between T-12 and L-2 using a pedicle screw-rod construct. Pedicle subtraction osteotomy was performed in 6 patients, and vertebral column resection was performed in 1 patient. The average follow-up period was 31 months (range 26-37 months). Computed tomography-based radiographic outcomes showed solid fusion and no instrumentation failure in all cases by the most recent follow-up. Five of 7 patients (71%) reported improvement in preoperative symptoms during the follow-up period. The mean differences in initial and most recent Scoliosis Research Society Outcomes Questionnaire and Oswestry Disability Index scores were 0.26 and -13%, respectively; minimum clinically important difference in SRS-22 and ODI were assumed to be 0.4% and -12.8%, respectively. CONCLUSIONS Spinal column shortening seems to represent a safe and efficacious alternative to traditional untethering of the spinal cord for tethered cord syndrome.
- Subjects :
- Adolescent
Adult
Child
Female
Follow-Up Studies
Humans
Laminectomy adverse effects
Lipoma diagnostic imaging
Lumbosacral Region diagnostic imaging
Lumbosacral Region surgery
Male
Meningomyelocele diagnostic imaging
Neural Tube Defects diagnostic imaging
Neural Tube Defects etiology
Retrospective Studies
Spinal Fusion adverse effects
Spinal Neoplasms diagnostic imaging
Treatment Outcome
Young Adult
Lipoma complications
Meningomyelocele complications
Neural Tube Defects surgery
Neurosurgical Procedures adverse effects
Spinal Cord surgery
Spinal Neoplasms complications
Subjects
Details
- Language :
- English
- ISSN :
- 1933-0715
- Volume :
- 19
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of neurosurgery. Pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 28362188
- Full Text :
- https://doi.org/10.3171/2017.1.PEDS16533