Pediatric tethered cord release: an epidemiological and postoperative complication analysis

Abhiraj D Bhimani; Ashley N Selner; Jay B Patel; Jonathan G Hobbs; Darian R Esfahani; Mandana Behbahani; Zaid Zayyad; Demetrios Nikas; Ankit I Mehta

doi:10.21037/jss.2019.09.02

Pediatric tethered cord release: an epidemiological and postoperative complication analysis

J Spine Surg. 2019 Sep;5(3):337-350. doi: 10.21037/jss.2019.09.02.

Authors

Abhiraj D Bhimani^{1

2}, Ashley N Selner¹, Jay B Patel¹, Jonathan G Hobbs³, Darian R Esfahani¹, Mandana Behbahani¹, Zaid Zayyad¹, Demetrios Nikas¹, Ankit I Mehta¹

Affiliations

¹ Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
² Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³ Section of Neurosurgery, The University of Chicago, Chicago, IL, USA.

Abstract

Background: Tethered cord release (TCR) is a common procedure in pediatric neurosurgery. Despite a reputation for being relatively safe, the risk factors for postoperative complications are poorly understood.

Methods: In this study, the American College of Surgeons-National Surgical Quality Improvement Program Pediatric Database (ACS-NSQIP-P) was reviewed to identify the demographics, risk factors, and 30-day postoperative complications for tethered cord release using univariate and multivariate analysis. A detailed analysis of reasons for readmission and reoperation was also performed.

Results: Three thousand and six hundred eighty-two pediatric patients were studied. Males undergoing TCR were younger (5.6 vs. 6.1 years) and had a higher rate of pre-operative comorbidities but lower 30-day complication rate versus females. Patients who later developed complications were more likely to require a microscope intraoperatively, had longer operative times, and worse preoperative American Society of Anesthesiologists (ASA) class.

Conclusions: Despite being a relatively safe procedure, TCR in the pediatric population carries a finite risk of complications. In this large, international database study, males were found to have a greater number of risk factors prior to TCR, while females exhibit a higher risk of developing postoperative complications. This paper provides a large sample size of multi institutional pediatric patients undergoing TCR and may serve as a contemporary "snapshot" for future studies.

Keywords: National Surgical Quality Improvement Program (NSQIP); Tethered cord syndrome (TCS); occult spinal dysraphism (OSD); tethered cord release (TCR).