Resident Physician University of Washington Seattle, Washington, United States
Introduction: Tethered cord syndrome refers to a constellation of symptoms characterized by neurological, musculoskeletal, and urinary symptoms, caused by traction on the spinal cord, which can be secondary to various etiologies. Surgical management for simple tethered cord etiologies (e.g. fatty filum) typically consists of a single-level lumbar laminectomy, intradural exploration, and coagulation and sectioning of the filum. Complex etiologies such as lipomyelomeningoceles, scar formation after myelomeningocele repair, intradural lipomas, and dermal sinus tracts involve complex dissection and dural reconstruction. We evaluate the experience of surgical management of pediatric tethered cord release at a tertiary children’s hospital, and to identify peri-operative factors which were associated with complications.
Methods: The records of children who underwent surgery for tethered cord release from July 2014 to August 2022 were retrospectively reviewed. Data collected included demographics, peri-operative characteristics, surgical technique, follow-up, and complications. Univariate and multivariate analysis were performed to identify risk factors associated with complications.
Results: 303 contiguous first-time TCRs at our institution were identified; 131 were simple TCRs and 172 were complex TCRs. The complication rate for simple TCRs was 5%, those for complex TCRs was 15%. Complications for complex TCRs developed sooner than that of simple etiologies. Prior TCR surgery was a risk factor for complications in simple TCRs. Increasing hospital length of stay was a risk factor for complications in complex TCRs (OR 1.05, 95% CI 1.01-1.10, p=0.027). Surgical technique and pre-existing medical and/or neurological comorbidities did not have any effect on post-operative complications.
Conclusion : We describe the experience of 303 TCR operations. Complications for simple TCRs are rare, whereas for complex TCRs occur at a higher rate. Special consideration should be made in cases of complex TCRs with respect to perioperative optimization, post-operative care, and follow-up to minimize complications.
