Disparities in Indications and Outcomes Reporting for Spinal Column Shortening for Tethered Cord Syndrome: The Need for a Standardized Approach

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

doi:10.1097/BRS.0000000000005009

Disparities in Indications and Outcomes Reporting for Spinal Column Shortening for Tethered Cord Syndrome: The Need for a Standardized Approach

Spine (Phila Pa 1976). 2024 Apr 12. doi: 10.1097/BRS.0000000000005009. Online ahead of print.

Authors

Matthew Findlay^{1

2}, Samuel A Tenhoeve^{1

2}, Chase Johansen³, Michael P Kelly⁴, Peter O Newton⁴, Rajiv R Iyer², John R W Kestle², David D Gonda⁴, Douglas L Brockmeyer², Vijay M Ravindra^{2

5}

Affiliations

¹ Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
² Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
³ Albany Medical College, Albany, New York, USA.
⁴ Division of Pediatric Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA.
⁵ Department of Neurological Surgery, Naval Medical Center San Diego, San Diego, California, USA.

PMID: 38605660
DOI: 10.1097/BRS.0000000000005009

Abstract

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.