title: Safety and efficacy of concurrent pediatric spinal cord untethering and deformity correction.
abstract: METHODS
  A retrospective clinical records analysis of concurrent pediatric spinal cord deformity correction and tethered cord release compared with a 2-staged approach.
  
  
  OBJECTIVE
  To compare the safety and efficacy of a single-staged approach for pediatric spinal deformity correction and tethered cord release to a conventional 2-staged approach.
  
  
  BACKGROUND
  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%).
  
  
  CONCLUSIONS
  Concurrent tethered cord release and spinal fusion for correction of scoliosis and/or kyphosis may be a safe and effective approach in patients likely to experience deformity progression.
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA. vivek.a.mehta@gmail.com
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Mehta
authors.forename: Oren N
authors.initials: ON
authors.lastname: Gottfried
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Edward S
authors.initials: ES
authors.lastname: Ahn
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D009436:Neural Tube Defects / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013116:Spinal Cord / Q000601:surgery; D016896:Treatment Outcome