Is detethering necessary before deformity correction in congenital scoliosis associated with tethered cord syndrome: a meta-analysis of current evidence.
Congenital scoliosis
Detethering
Intraspinal anomalies
Neurological complications
Surgical outcomes
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
29
09
2020
accepted:
07
11
2020
revised:
29
09
2020
pubmed:
18
11
2020
medline:
3
7
2021
entrez:
17
11
2020
Statut:
ppublish
Résumé
To compare the clinical and radiological outcomes in patients with congenital scoliosis (CS) and tethered cord syndrome (TCS) undergoing deformity correction with (NI group) versus without (NNI group) prior neurosurgical intervention aimed at detethering the cord. A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until March 2020. Inclusion criteria was studied describing performance of deformity correction and fusion surgery for congenital scoliosis with tethered cord syndrome with or without prior detethering procedure. Studies describing growth sparing procedures or congenital scoliosis associated with non-tethering pathologies such as syrinx were excluded. Case reports and series with less than 10 subjects were also excluded. NIH quality assessment tool was used for assessing quality of individual study. Sixteen studies were included for analysis of which eight were found to be retrospective case series (level IV evidence) and retrospective case-control studies (level III evidence) each. Overall proportional meta-analysis found no significant difference in correction rate, operative duration, blood loss or complication rate between the NI and NNI groups. However, subgroup analysis performed after inclusion of only level III evidence studies revealed significantly lesser operative duration and blood loss with comparable correction and complication rate in NNI group. Deformity correction and fusion surgery may be performed safely and effectively in CS with TCS patients without the need of a prior detethering procedure.
Identifiants
pubmed: 33201289
doi: 10.1007/s00586-020-06662-7
pii: 10.1007/s00586-020-06662-7
doi:
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
599-611Commentaires et corrections
Type : CommentIn
Type : CommentIn
Références
Basu PS, Elsebaie H, Noordeen MHH (2002) Congenital spinal deformity: a comprehensive assessment at presentation. Spine 27:2255–2259. https://doi.org/10.1097/00007632-200210150-00014
doi: 10.1097/00007632-200210150-00014
pubmed: 12394903
Shen J, Wang Z, Liu J et al (2013) Abnormalities associated with congenital scoliosis: a retrospective study of 226 Chinese surgical cases. Spine 8:814–818. https://doi.org/10.1097/BRS.0b013e31827ed125
doi: 10.1097/BRS.0b013e31827ed125
Kokubun S, Ozawa H, Aizawa T et al (2011) Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. J Neurosurg Spine 15:21–27. https://doi.org/10.3171/2011.2.SPINE10114
doi: 10.3171/2011.2.SPINE10114
pubmed: 21495816
Hedequist D, Emans J (2007) Congenital scoliosis: a review and update. J Pediatr Orthop 27:106–116. https://doi.org/10.1097/BPO.0b013e31802b4993
doi: 10.1097/BPO.0b013e31802b4993
pubmed: 17195809
Jayaswal A, Kandwal P, Goswami A et al (2016) Early onset scoliosis with intraspinal anomalies: management with growing rod. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 25:3301–3307. https://doi.org/10.1007/s00586-016-4566-5
doi: 10.1007/s00586-016-4566-5
Barutçuoğlu M, Selçuki M, Umur AS et al (2016) Scoliosis may be the first symptom of the tethered spinal cord. Indian J Orthop 50:80–86. https://doi.org/10.4103/0019-5413.173506
doi: 10.4103/0019-5413.173506
pubmed: 26955181
pmcid: 4759880
Yamada S, Won DJ, Yamada SM (2004) Pathophysiology of tethered cord syndrome: correlation with symptomatology. Neurosurg Focus 16:E6. https://doi.org/10.3171/foc.2004.16.2.7
doi: 10.3171/foc.2004.16.2.7
pubmed: 15209489
McLone DG, Herman JM, Gabrieli AP, Dias L (1990) Tethered cord as a cause of scoliosis in children with a myelomeningocele. Pediatr Neurosurg 16:8–13. https://doi.org/10.1159/000120495
doi: 10.1159/000120495
pubmed: 2133414
Mehta VA, Gottfried ON, McGirt MJ et al (2011) Safety and efficacy of concurrent pediatric spinal cord untethering and deformity correction. J Spinal Disord Tech 24:401–405. https://doi.org/10.1097/BSD.0b013e3182019f4d
doi: 10.1097/BSD.0b013e3182019f4d
pubmed: 21150661
Hamzaoglu A, Ozturk C, Tezer M et al (2007) Simultaneous Surgical Treatment in Congenital Scoliosis and/or Kyphosis Associated With Intraspinal Abnormalities. Spine 32:2880–2884. https://doi.org/10.1097/BRS.0b013e31815b60e3
doi: 10.1097/BRS.0b013e31815b60e3
pubmed: 18246012
Chen B, Yuan Z, Chang MS et al (2015) Safety and Efficacy of One-stage Spinal Osteotomy for Severe and Rigid Congenital Scoliosis Associated with Split Spinal Cord Malformation. Spine 40:E1005-1013. https://doi.org/10.1097/BRS.0000000000001039
doi: 10.1097/BRS.0000000000001039
pubmed: 26165211
Singrakhia M, Malewar N, Deshmukh S, Deshmukh S (2018) Simultaneous Surgical Treatment of Congenital Spinal Deformity Associated with Intraspinal Anomalies. Asian Spine J 12:466–475. https://doi.org/10.4184/asj.2018.12.3.466
doi: 10.4184/asj.2018.12.3.466
pubmed: 29879774
pmcid: 6002162
Chern JJ, Dauser RC, Whitehead WE et al (2011) The effect of tethered cord release on coronal spinal balance in tight filum terminale. Spine 36:E944-949. https://doi.org/10.1097/BRS.0b013e3181fc2edd
doi: 10.1097/BRS.0b013e3181fc2edd
pubmed: 21289577
Kulwin CG, Patel NB, Ackerman LL et al (2013) Radiographic and clinical outcome of syringomyelia in patients treated for tethered cord syndrome without other significant imaging abnormalities. J Neurosurg Pediatr 11:307–312. https://doi.org/10.3171/2012.11.PEDS12251
doi: 10.3171/2012.11.PEDS12251
pubmed: 23259548
Ayvaz M, Alanay A, Yazici M et al (2007) Safety and efficacy of posterior instrumentation for patients with congenital scoliosis and spinal dysraphism. J Pediatr Orthop 27:380–386. https://doi.org/10.1097/01.bpb.0000271334.73643.81
doi: 10.1097/01.bpb.0000271334.73643.81
pubmed: 17513956
Matsumoto M, Watanabe K, Tsuji T et al (2009) Progressive kyphoscoliosis associated with tethered cord treated by posterior vertebral column resection: a case report. Spine 34:E965-968. https://doi.org/10.1097/BRS.0b013e3181af7a6a
doi: 10.1097/BRS.0b013e3181af7a6a
pubmed: 20010386
Altiok H, Riordan A, Graf A et al (2016) Response of Scoliosis in Children with Myelomeningocele to Surgical Release of Tethered Spinal Cord. Top Spinal Cord Inj Rehabil 22:247–252. https://doi.org/10.1310/sci2204-247
doi: 10.1310/sci2204-247
pubmed: 29339865
pmcid: 5108508
McGirt MJ, Mehta V, Garces-Ambrossi G et al (2009) Pediatric tethered cord syndrome: response of scoliosis to untethering procedures: Clinical article. J Neurosurg Pediatr 4:270–274. https://doi.org/10.3171/2009.4.PEDS08463
doi: 10.3171/2009.4.PEDS08463
pubmed: 19772413
Fang F, Shen J, Zhou J et al (2016) Clinical Outcomes of Different Surgical Strategy for Patients With Congenital Scoliosis and Type I Split Cord Malformation. Spine 41:1310–1316. https://doi.org/10.1097/brs.0000000000001530
doi: 10.1097/brs.0000000000001530
Hui H, Tao H-R, Jiang X-F et al (2012) Safety and Efficacy of 1-Stage Surgical Treatment of Congenital Spinal Deformity Associated With Split Spinal Cord Malformation. Spine 37:2104–2113. https://doi.org/10.1097/BRS.0b013e3182608988
doi: 10.1097/BRS.0b013e3182608988
pubmed: 22648030
Zhao Q, Shi B, Sun X et al (2019) Do untreated intraspinal anomalies in congenital scoliosis impact the safety and efficacy of spinal correction surgery? A retrospective case-control study. J Neurosurg Spine 31:40–45. https://doi.org/10.3171/2019.1.SPINE181205
doi: 10.3171/2019.1.SPINE181205
pubmed: 30952134
Study Quality Assessment Tools | NHLBI, NIH. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools . Accessed 25 Sep 2020
Tao H, Yang K, Li T et al (2019) Is It Possible to Correct Congenital Spinal Deformity Associated With a Tethered Cord Without Prophylactic Intradural Detethering? Clin Orthop 477:1689–1697. https://doi.org/10.1097/CORR.0000000000000652
doi: 10.1097/CORR.0000000000000652
pubmed: 30801282
Zhang Z, Hui H, Liu T et al (2016) Two-staged correction of Severe Congenital Scoliosis Associated with Intraspinal Abnormalities. Clin Spine Surg 29:E401-405. https://doi.org/10.1097/BSD.0000000000000175
doi: 10.1097/BSD.0000000000000175
pubmed: 25310398
Sun K, Hu H, Gao L et al (2020) Perioperative Halo-Gravity Traction in the Treatment of Scoliosis with Intraspinal Anomalies. World Neurosurg 140:e219–e224. https://doi.org/10.1016/j.wneu.2020.04.242
doi: 10.1016/j.wneu.2020.04.242
pubmed: 32407918
Huang J-H, Yang W-Z, Shen C et al (2015) Surgical Treatment of Congenital Scoliosis Associated With Tethered Cord by Thoracic Spine-shortening Osteotomy Without Cord Detethering. Spine 40:E1103-1109. https://doi.org/10.1097/BRS.0000000000001035
doi: 10.1097/BRS.0000000000001035
pubmed: 26110661
Huang Z, Li X, Deng Y et al (2019) The Treatment of Severe Congenital Scoliosis Associated With Type I Split Cord Malformation: Is a Preliminary Bony Septum Resection Always Necessary? Neurosurgery 85:211–222. https://doi.org/10.1093/neuros/nyy237
doi: 10.1093/neuros/nyy237
pubmed: 30060239
Shen J, Zhang J, Feng F et al (2016) Corrective Surgery for Congenital Scoliosis Associated with Split Cord Malformation: It May Be Safe to Leave Diastematomyelia Untreated in Patients with Intact or Stable Neurological Status. J Bone Joint Surg Am 98:926–936. https://doi.org/10.2106/JBJS.15.00882
doi: 10.2106/JBJS.15.00882
pubmed: 27252437
Udayakumaran S, Menon SK, Onyia CU, Tahasildar N (2017) Single-stage deformity correction in children with neurogenic kyphoscoliosis: nuances and a proposal for risk stratification. Neurosurg Focus 43:E13. https://doi.org/10.3171/2017.7.FOCUS17348
doi: 10.3171/2017.7.FOCUS17348
pubmed: 28965455
Zhou Z, Zhang H, Guo C et al (2017) More preoperative flexibility implies adequate neural pliability for curve correction without prophylactic untethering in scoliosis patients with asymptomatic tethered spinal cord, a retrospective study. BMC Musculoskelet Disord 18(1):261. https://doi.org/10.1186/s12891-017-1615-0
doi: 10.1186/s12891-017-1615-0
pubmed: 28619063
pmcid: 5472950
Yang N, Luo M, Yu Y et al (2019) Is It Better to Resect a Bony Spur Before Corrective Surgery for Congenital Scoliosis with Type I Split Cord Malformation? World Neurosurg 125:e1151–e1159. https://doi.org/10.1016/j.wneu.2019.01.265
doi: 10.1016/j.wneu.2019.01.265
pubmed: 30790730
Winter RB, Haven JJ, Moe JH, Lagaard SM (1974) Diastematomyelia and congenital spine deformities. J Bone Joint Surg Am 56:27–39
doi: 10.2106/00004623-197456010-00003
Pierz K, Banta J, Thomson J et al (2000) The effect of tethered cord release on scoliosis in myelomeningocele. J Pediatr Orthop 20:362–365
pubmed: 10823605
Sinha S, Agarwal D, Mahapatra AK (2006) Split cord malformations: an experience of 203 cases. Childs Nerv Syst 22:3–7. https://doi.org/10.1007/s00381-005-1145-1
doi: 10.1007/s00381-005-1145-1
pubmed: 15933885
Gupta DK, Ahmed S, Garg K, Mahapatra AK (2010) Regrowth of Septal Spur in Split Cord Malformation. Pediatr Neurosurg 46:242–244. https://doi.org/10.1159/000318753
doi: 10.1159/000318753
pubmed: 21051925
Pang D, Parrish RG (1983) Regrowth of diastematomyelic bone spur after extradural resection case report. J Neurosurg 59:887–890. https://doi.org/10.3171/jns.1983.59.5.0887
doi: 10.3171/jns.1983.59.5.0887
pubmed: 6619944
Samdani AF, Asghar J, Pahys J et al (2007) Concurrent spinal cord untethering and scoliosis correction: case report. Spine 32:E832–E883. https://doi.org/10.1097/BRS.0b013e31815ce6ae
doi: 10.1097/BRS.0b013e31815ce6ae
pubmed: 18091479
Mooney JF, Glazier SS, Barfield WR (2012) Concurrent orthopedic and neurosurgical procedures in pediatric patients with spinal deformity. J Pediatr Orthop Part B 21:602–605. https://doi.org/10.1097/BPB.0b013e328357ea38
doi: 10.1097/BPB.0b013e328357ea38
Oda JE, Shah SA, Mackenzie WG et al (2012) Concurrent Tethered Cord Release and Growing-Rod Implantation—Is It Safe? Glob Spine J 2:207–212. https://doi.org/10.1055/s-0032-1330941
doi: 10.1055/s-0032-1330941
Li S, Ou Y, Liu B et al (2015) Comparison of osteotomy versus non-osteotomy approach for congenital scoliosis: a retrospective study of three surgical techniques. Anz J Surg 85:249–254. https://doi.org/10.1111/ans.12886
doi: 10.1111/ans.12886
pubmed: 25316619
Wang S, Aikenmu K, Zhang J et al (2017) The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis. Eur Spine J 26:1817–1825. https://doi.org/10.1007/s00586-015-4344-9
doi: 10.1007/s00586-015-4344-9
pubmed: 26661847
Kandwal P, Goswami A, Vijayaraghavan G et al (2016) Staged Anterior Release and Posterior Instrumentation in Correction of Severe Rigid Scoliosis (Cobb Angle >100 Degrees). Spine Deform 4:296–303. https://doi.org/10.1016/j.jspd.2015.12.005
doi: 10.1016/j.jspd.2015.12.005
pubmed: 27927520
Kandwal P, Vijayaraghavan GP, Nagaraja UB, Jayaswal A (2017) Severe Rigid Scoliosis: Review of Management Strategies and Role of Spinal Osteotomies. Asian Spine J 11:494–503. https://doi.org/10.4184/asj.2017.11.3.494
doi: 10.4184/asj.2017.11.3.494
pubmed: 28670419
pmcid: 5481606
Weiss H-R, Goodall D (2008) Rate of complications in scoliosis surgery–a systematic review of the Pub Med literature. Scoliosis 3:9. https://doi.org/10.1186/1748-7161-3-9
doi: 10.1186/1748-7161-3-9
pubmed: 18681956
pmcid: 2525632
Yaltırık K, El Tecle NE, Pierson MJ et al (2017) Management of concomitant scoliosis and tethered cord syndrome in non-spina bifida pediatric population. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 33:1899–1903. https://doi.org/10.1007/s00381-017-3504-0
doi: 10.1007/s00381-017-3504-0
Kawahara N, Tomita K, Kobayashi T et al (2005) Influence of acute shortening on the spinal cord: an experimental study. Spine 30:613–620. https://doi.org/10.1097/01.brs.0000155407.87439.a2
doi: 10.1097/01.brs.0000155407.87439.a2
pubmed: 15770174