Tethered cord syndrome (TCS) is frequently associated with
scoliosis in the pediatric population. Conventional practice suggests waiting several months after untethering for
scoliosis correction; however, some patients will experience progression of their spinal
deformity. We report the efficacy and safety of concurrent tethered cord release and
scoliosis and/or
kyphosis deformity correction in a series of pediatric patients.
METHODS: We retrospectively reviewed 15 consecutive pediatric cases of concurrent spinal cord untethering and
deformity correction with fusion for
scoliosis and/or
kyphosis. The clinical and radiologic presentation, operative details, morbidity, and postoperative outcomes were evaluated. Outcomes of this cohort were then compared with 21 patients who underwent a 2-staged untethering surgery followed by
scoliosis correction. We provide a review of the literature of the treatment of tethered cord associated with spine
deformities.
RESULTS: The mean age of patients undergoing concurrent untethering and curve correction was 9.6 years (5 male, 10 female). Tethered cord was because of
myelomeningocele (5 patients), thickened filum terminale (5 patients),
lipomyelomeningocele (4 patients), and retethering from an unknown primary TCS etiology (1 patient). The mean
scoliosis Cobb angle (±SD) at presentation was 55.4±21.0 degrees (range, 32.3 degrees to 95.0 degrees) whereas average
kyphosis was 112.7±43.6 degrees (range, 68.0 degrees to 155.0 degrees). Average postoperative
scoliosis curve was 40.0 degrees, resulting in an average correction of 27%;
kyphosis curve was 55.7 degrees resulting in an average correction of 50%. The average operation time was 8.6 hours (range, 3.9 to 13.7 h) and the average blood loss was 1266 mL (range, 400 to 5000 mL). Average length of hospitalization was 10.1 days (range, 4 to 34 d). New onset or worsening of
neurologic deficits, bowel or bladder dysfunction, or TCS associated
pain did not occur in any patients. At a mean follow-up of 5.7 years (range, 1.3 to 11.8 y), only 1 (7%) patient required subsequent surgery for
pseudoarthrosis. The 2-staged cohort experienced a longer cumulative
operative time (11.2 vs 8.6 h, P<0.05), more total blood loss (1534 vs 1266 mL, P<0.05), longer total days of hospitalization (14.8 vs 10.1 d, P<0.05), and a greater incidence of dural tear (9.5% vs 0%),
wound infection (26% vs 0%), and retethering (9.5% vs 0%).
CONCLUSION: