title: Surgical Treatment of Congenital Scoliosis Associated With Tethered Cord by Thoracic Spine-shortening Osteotomy Without Cord Detethering.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  To investigate the safety and efficacy of spine-shortening osteotomy for congenital scoliosis with tethered cord.
  
  
  BACKGROUND
  Conventional surgery for congenital scoliosis associated with tethered cord risks the complications of detethering. Spine-shortening osteotomy holds the potential to correct scoliosis and decrease spinal cord tension simultaneously without an extra detethering procedure, but no data on this issue is available.
  
  
  METHODS
  21 patients (14 females and 7 males, average age 15.4 yr) underwent spine-shortening osteotomy without detethering. All of the patients had tethered cord. Patients with main curve more than 90° underwent vertebral column resection (VCR), whereas the others had pedicle subtraction osteotomy (PSO) performed. The average postoperative follow-up period was 45.2 months.
  
  
  RESULTS
  The mean operation time was 544.5 min with average blood loss of 2769.1 ml. The deformity correction was 61.3% in the coronal plane and 43.9° in the sagittal plane. 10 patients had neurological deficits preoperatively. At the final follow-up, the deficits in 8 (80%) patients were significantly improved, whereas 2 (20%) remained unchanged. At final follow-up, 71.4% (5/7) patients reported improvement in motor function, 100% (3/3) had improved pain scores, and 75% (3/4) reported better sensory function after the spine-shortening osteotomy. Urinary dysfunction and bowel incontinence present preoperatively in 3 patients all recovered by final follow-up. 5 (23.8%) patients incurred complications including temporary neurological deterioration in 1 patient, urinary tract infection in 2 patients, cerebrospinal fluid leakage in 1 patient, and blood loss more than 5000 ml in 1 patient.
  
  
  CONCLUSIONS
  Spine-shortening osteotomy is a safe and effective procedure for congenital scoliosis associated with tethered cord. Spine-shortening osteotomy at the thoracic apical vertebrae level not only corrects the spine deformity but also simultaneously releases the tension of the tethered cord, resulting in improved neurologic function.
authors.affiliation: *Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China†Adult and Pediatric Spine Surgery, Sonoran Spine Center, Mesa, AZ; and‡Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Jing-Hui
authors.initials: JH
authors.lastname: Huang
authors.forename: Wei-Zhou
authors.initials: WZ
authors.lastname: Yang
authors.forename: Chao
authors.initials: C
authors.lastname: Shen
authors.forename: Michael S
authors.initials: MS
authors.lastname: Chang
authors.forename: Huan
authors.initials: H
authors.lastname: Li
authors.forename: Zhuo-Jing
authors.initials: ZJ
authors.lastname: Luo
authors.forename: Hui-Ren
authors.initials: HR
authors.lastname: Tao
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009436:Neural Tube Defects / Q000150:complications / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult