Disparities in Indications and Outcomes Reporting for Spinal Column Shortening for Tethered Cord Syndrome
Matthew Findlay, Samuel A. Tenhoeve, Chase Johansen, Michael P. Kelly, Peter O. Newton, Rajiv R. Iyer, John R.W. Kestle, David D. Gonda, Douglas L. Brockmeyer, Vijay M. Ravindra- Neurology (clinical)
- Orthopedics and Sports Medicine
Study Design.
Systematic review.
Objective.
To identify commonly reported indications and outcomes in spinal column shortening (SCS) procedures.
Summary of Background Data.
SCS is a surgical procedure used in patients with tethered cord syndrome (TCS)—characterized by abnormal attachment of neural components to surrounding tissues—to shorten the vertebral column, release tension on the spinal cord/neural elements, and alleviate associated symptoms.
Methods.
PubMed and EMBASE searches captured SCS literature published between 1950 and 2023. Prospective/retrospective cohort studies and case series were included without age limit or required follow-up period. Review articles without new patient presentations, meta-analyses, systematic reviews, conference abstracts, and letters were excluded. Studies included adult and pediatric patients.
Results.
The 29 identified studies represented 278 patients (age 5–76 y). In 24.1% of studies, patients underwent primary TCS intervention via SCS. In 41.4% of studies, patients underwent SCS after failed previous primary detethering (24.1% of studies were mixed and 10.3% were unspecified). The most commonly reported non-genitourinary/bowel surgical indications were back pain (55.2%), lower-extremity pain (48.3%), lower-extremity weakness (48.3%), lower-extremity numbness (34.5%), and lower-extremity motor dysfunction (34.5%). Genitourinary/bowel symptoms were most often described as nonspecific bladder dysfunction (58.6%), bladder incontinence (34.5%), and bowel dysfunction (31.0%). After SCS, non-genitourinary/bowel outcomes included lower-extremity pain (44.8%), back pain (31.0%), and lower-extremity sensory and motor function (both 31.0%). Bladder dysfunction (79.3%), bowel dysfunction (34.5%), and bladder incontinence (13.8%) were commonly reported genitourinary/bowel outcomes. In total, 40 presenting surgical indication categories and 33 unique outcome measures were reported across studies. Seventeen of the 278 patients (6.1%) experienced a complication.
Conclusion.
The SCS surgical literature displays variability in operative indications and postoperative outcomes. The lack of common reporting mechanisms impedes higher-level analysis. A standardized outcomes measurement tool, encompassing both patient-reported outcome measures and objective metrics, is necessary.
Level of Evidence.
Level 4