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Tethered Cord Release in Myelomeningocele: An Investigation on the Effect of Tethered Cord Release on Tethered Cord Syndrome Related Procedures

Maí 2017

Introduction: Tethered cord syndrome (TCS) is a functional disorder caused by anchoring of the spinal cord at its caudal end by an inelastic structure. Such anchoring of the spinal cord induces stretching, disrupting the normal physiology of the spinal cord, which can lead to symptoms such as back and leg pain, progressive motor and sensory deficits in the lower limbs, neurogenic bladder and bowel dysfunction, and scoliosis. Many of these symptoms require surgical treatment. The primary treatment for TCS is surgical tethered cord release (TCR). Surgical results vary, however, between groups of patients with TCS. The group with the worst outcome in improvement of symptoms are patients with myelomeningocele (MMC). The aim of this study was to investigate the effect of TCR surgery on the frequency of TCS related surgeries in patients with MMC.
Methods: A study population from a previous study in our research group was adopted. The study group included patients in the Western Denmark Myelomeningocele Database, which contains all patients born with MMC in western Denmark from January 1st, 1970 to the present. A cross-reference had previously been performed on June 19th, 2015 with the study population and the Central Denmark Region database at Aarhus University Hospital. Information on procedures on MMC patients that were alive at any point in time between January 1st, 1996 and June 19th, 2015 was extracted. Data was collected on orthopedic surgery, occipito-cervical decompression, neurogenic bladder and bowel dysfunction surgery, dermal ulcer surgery, spondylodesis, and shunt surgery. Data on shunt surgery was used as a control as it was not expected to be affected by TCR. Data on each surgery category was compared between two groups of patients, TCR and non-TCR. Data was also compared within the TCR group, before and after TCR. Age at surgery, years at risk, and incidence rates of each surgery per year of age and per year at risk were calculated.
Results: A total of 166 patients were included in the study. 45 patients (27%) had undergone TCR, seven of which were reoperated (16%). A total of 52 TCR operations were performed over the study time period, yielding an incidence of 18,1 operations per 1.000 years at risk. The average age at TCR was 12,33 years [1,3-29,4 years]. No significant difference was found between the number of TCS related operations between groups (TCR vs. non-TCR) in any surgery category, or within the TCR group (before and after TCR).
Conclusion: TCR does not seem to have an effect on the number of TCS related surgeries in patients with MMC. This supports the hypothesis that TCR in patients with MMC does not improve symptoms of TCS.


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