title: [Homogeneous spinal-shortening axial decompression procedure for tethered cord syndrome].
abstract: OBJECTIVE
  Surgical detethering is a traditional treatment for symptomatic tethered cord syndrome. However, such complications as cerebrospinal fluid leakage and neurologic deterioration are common. Homogeneous spinal-shortening axial decompression (HSAD) is a modified procedure of monosegmental spinal-shortening osteotomy and it is a novel surgical alternative of reducing neural tension indirectly. The objective was to evaluate the surgical outcomes of HSAD for tethered cord syndrome.
  
  
  METHODS
  The surgical outcomes were examined for 15 consecutive patients with tethered cord syndrome undergoing HSAD from April 2010 to July 2014. Improvements of neurological symptoms including urinary dysfunction, lower-extremity motor and sensory disturbances and/or gait abnormalities, low-back and/or lower-extremity pain, bowel incontinence and sexual dysfunction were evaluated.
  
  
  RESULTS
  Their average follow-up period was 21.5 months. The length of spinal column shortening was 17.2 ± 2.9 mm. Urinary dysfunction (n = 9) was the most common residual deficit. All 9 patients with urological symptoms reported improvements, although deficits persisted at the last follow-up. All patients with lower-extremity motor dysfunction improved and 4 (50.0%) noted complete resolution of preoperative lower-extremity sensory symptoms. All patients reported immediate low-back or lower-extremity pain relief after HSAD. One patient reported improved sexual functioning and regained complete erectile capabilities. Two patients (11%) experienced less satisfactory symptomatic or functional benefit from HSAD. However, the main objective of surgery was to prevent further worsening of neurological status. Complete bone union at osteotomy site was noted in all cases at the last follow-up.
  
  
  CONCLUSIONS
  As a novel surgical option for tethered cord syndrome, HSAD may avoid such complications as cerebrospinal fluid leakage or neurologic deterioration commonly encountered during traditional detethering surgery. All patients gain satisfactory functional outcomes without complications compared to their preoperative symptoms.
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; Shanghai Tongji University, Shanghai 200092, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; Shanghai Tongji University, Shanghai 200092, China.
authors.forename: Jingchuan
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; Shanghai Tongji University, Shanghai 200092, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; Shanghai Tongji University, Shanghai 200092, China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; Shanghai Tongji University, Shanghai 200092, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Xu
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; Shanghai Tongji University, Shanghai 200092, China.
authors.forename: Kefu
authors.initials: K
authors.lastname: Chen
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; Shanghai Tongji University, Shanghai 200092, China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Shi
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; Shanghai Tongji University, Shanghai 200092, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Yuan
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; Shanghai Tongji University, Shanghai 200092, China.
authors.forename: Lianshun
authors.initials: L
authors.lastname: Jia
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; Shanghai Tongji University, Shanghai 200092, China; Email: shijiangangspine@163.com.
authors.forename: Jiangang
authors.initials: J
authors.lastname: Shi
mesh_terms: D019299:Decompression, Surgical; D006801:Humans; D009436:Neural Tube Defects; D019635:Neurosurgical Procedures; D010027:Osteotomy; D010146:Pain; D012678:Sensation Disorders; D013131:Spine