Trends in the presentation, surgical treatment, and outcomes of tethered cord syndrome: A nationwide study from 2001 to 2010.
OBJECTIVE
This is a nationwide query into surgical management techniques for tethered cord syndrome, focusing on patient demographic, hospital characteristics, and treatment outcomes. Our hypothesis is that detethering vs. fusion for TCS results in different in-hospital complications.


METHODS
Retrospective review of the Nationwide Inpatient Sample 2001-2010. Inclusion: TCS discharges undergoing detethering or fusion. Sub-analysis compared TCS cases by age (pediatric [≤9years] vs. adolescent [10-18year]). Independent t-tests identified differences between fusion and detethering for hospital-related and surgical factors; multivariate analysis investigated procedure as a risk factor for complications/mortality.


RESULTS
6457 TCS discharges: 5844 detetherings, 613 fusions. Fusion TCS had higher baseline Deyo Index (0.16 vs. 0.06), procedure-related complications (21.3% vs. 7.63%), and mortality (0.33% vs. 0.09%) than detethering, all p<0.001. Detethering for TCS was a significant factor for reducing mortality (OR 0.195, p<0.001), cardiac (OR 0.27, p<0.001), respiratory (OR 0.26, p<0.001), digestive system (OR 0.32, p<0.001), puncture nerve/vessel (OR 0.56, p=0.009), wound (OR 0.25, p<0.001), infection (OR 0.29, p<0.001), posthemorrhagic anemia (OR 0.04, p=0.002), ARDS (OR 0.13, p<0.001), and venous thrombotic (OR 0.53, p=0.043) complications. Detethering increased nervous system (OR 1.34, p=0.049) and urinary (OR 2.60, p<0.001) complications. Adolescent TCS had higher Deyo score (0.08 vs. 0.03, p<0.001), LOS (5.77 vs. 4.13days, p<0.001), and charges ($54,592.28 vs. $33,043.83, p<0.001), but similar mortality. Adolescent TCS discharges had increased prevalence of all procedure-related complications, and higher overall complication rate (11.10% vs. 5.08%, p<0.001) than pediatric.


CONCLUSIONS
With fusion identified as a significant risk factor for mortality and multiple procedure-related complications in TCS surgical patients, this study could aid surgeons in counseling TCS patients to optimize outcomes.
Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA.
Cyrus M
CM
Jalai
Eastern Virginia Medical School, Norfolk, VA, USA.
Charles
C
Wang
Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, MD, USA.
Bryan J
BJ
Marascalchi
Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA.
Samantha R
SR
Horn
Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA.
Gregory W
GW
Poorman
Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA.
Olivia J
OJ
Bono
Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA.
Anthony K
AK
Frempong-Boadu
NY Spine Institute/Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA. Electronic address: Peter.Passias@nyumc.org.
Peter G
PG
Passias
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009436:Neural Tube Defects / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D010351:Patient Discharge / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome
Detethering vs. fusion; In-hospital complications; Surgical management; Tethered cord syndrome