title: Spinal cord detethering procedures in children: a 5 year retrospective cohort study of the early post-operative course.
abstract: Tethered spinal cord can cause neurological, orthopaedic and sphincteric problems in children and detethering surgery may prevent or reverse these problems. This 5 year retrospective cohort study aimed to review our experience of detethering surgery at The Children's Hospital at Westmead, Sydney, Australia, particularly examining the early post-operative complications of this procedure. Between 2007 and 2012, 61 children underwent 63 detethering procedures. The median age at detethering surgery was 1.4 years old (interquartile range: 0.7-5.6 years). Fifty-five children (90.1%) had lumbosacral procedures, 31 (50.8%) were asymptomatic from tethering, 11 (18.0%) had motor or gait disturbance, 11 (18.0%) sphincteric disturbance, eight (13.1%) lower limb orthopaedic deformities, eight (13.1%) scoliosis, six (9.8%) back or leg pain and two (3.3%) sensory disturbance. The most common tethering pathologies were spinal lipomas in 32 children (52.5%), filum abnormalities in 23 (37.7%), dorsal sinus tracts in eight (13.1%) and diastematomyelia in seven (11.5%). Twenty-six children (42.6%) had either a syrinx or central canal dilatation preoperatively. The most common complications were wound infection and cerebrospinal fluid leak. Six children (9.8%) required reoperation for wound issues and two patients (3.3%) required subsequent reoperation for cord retethering during the study period. There were no deaths and no new neurological deficits. Of the children with the above preoperative deficits, 26.7% were documented to have improvement or resolution of their symptoms post-operatively. The highest rate of improvement occurred in children with motor or gait disturbance (36.4%) or sphincteric disturbance (27.3%).
authors.affiliation: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. Electronic address: matthew.thuy@gmail.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Thuy
authors.affiliation: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Chaseling
authors.affiliation: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Fowler
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009436:Neural Tube Defects / Q000175:diagnosis / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000639:trends*; D010146:Pain / Q000175:diagnosis / Q000601:surgery; D011182:Postoperative Care / Q000639:trends*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D012086:Reoperation / Q000639:trends; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000601:surgery; D012678:Sensation Disorders / Q000175:diagnosis / Q000601:surgery; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000601:surgery*; D013595:Syringomyelia / Q000175:diagnosis / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: Australia; Paediatric neurosurgery; Tethered spinal cord syndrome