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Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty.
Childs Nerv Syst. 2009 Sep; 25(9):1085-9.CN

Abstract

BACKGROUND

Cord retethering and other postoperative complications can occur after the surgical untethering of a first-time symptomatic tethered cord. It is unclear if using duraplasty vs. primary dural closure in the initial operation is associated with decreased incidence of either immediate postoperative complications or subsequent symptomatic retethering. It is also unclear if different etiologies are associated with different outcomes after each method of closure. We reviewed our pediatric experience in first-time surgical untethering of symptomatic tethered cord syndrome (TCS) to identify the incidence of postoperative complications and symptomatic retethering after duraplasty vs. primary closure.

MATERIALS AND METHODS

We retrospectively reviewed 110 consecutive pediatric (<18 years old) cases of first-time symptomatic spinal cord untethering at our institution over a 10-year period. Incidence of postoperative complications and symptomatic retethering were compared in cases with duraplasty vs. primary dural closure use.

RESULTS

Mean age was 5.7 +/- 4.8 years old. "Complex" etiologies included lipomyelomeningocele or prior lipomyelomeningocele repair in 22 (20%) patients, prior myelomeningocele repair in 35 (32%), and concurrent lumbosacral lipoma in 18 (16%). "Noncomplex etiologies" included fatty filum in 26 (24%) and split cord malformation in five (4%). Seventy-five (68%) cases underwent primary dural closure vs. 35 (32%) with duraplasty. Twenty-nine (26%) patients experienced symptomatic retethering at a median [interquartile range (IQR)] of 30.5 [20.75-41.75] months postoperatively. There was no difference in incidence of postoperative cerebrospinal fluid leak, surgical site infection, or median [IQR] length of stay in patients receiving primary dural closure [4 (5%), 7 (9%), and 5 (4-6) days, respectively] vs. duraplasty [3 (9%), 3 (9%), and 6 [5-8] days, respectively], p > 0.05. Complex etiologies were more likely to retether than noncomplex etiologies after primary closure (33.6% vs. 6.6%, p = 0.05) but not after duraplasty (13.7% vs. 5.4%, p = 0.33). Duraplasty graft type (polytetrafluoroethylene vs. bovine pericardium) was not associated with pseudomeningocele or retethering.

CONCLUSION

In our experience, the increased rate of symptomatic retethering observed with complex pediatric TCS (pTCS) etiologies after primary dural closures was not observed when duraplasty was instituted. Expansile duraplasty may be valuable specifically in the management of patient subgroups with complex pTCS etiologies.

Authors+Show Affiliations

Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Meyer 8-161, Baltimore, MD 21287, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19418057

Citation

Samuels, Roger, et al. "Incidence of Symptomatic Retethering After Surgical Management of Pediatric Tethered Cord Syndrome With or Without Duraplasty." Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, vol. 25, no. 9, 2009, pp. 1085-9.
Samuels R, McGirt MJ, Attenello FJ, et al. Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty. Childs Nerv Syst. 2009;25(9):1085-9.
Samuels, R., McGirt, M. J., Attenello, F. J., Garcés Ambrossi, G. L., Singh, N., Solakoglu, C., Weingart, J. D., Carson, B. S., & Jallo, G. I. (2009). Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty. Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, 25(9), 1085-9. https://doi.org/10.1007/s00381-009-0895-6
Samuels R, et al. Incidence of Symptomatic Retethering After Surgical Management of Pediatric Tethered Cord Syndrome With or Without Duraplasty. Childs Nerv Syst. 2009;25(9):1085-9. PubMed PMID: 19418057.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty. AU - Samuels,Roger, AU - McGirt,Matthew J, AU - Attenello,Frank J, AU - Garcés Ambrossi,Giannina L, AU - Singh,Neil, AU - Solakoglu,Can, AU - Weingart,Jon D, AU - Carson,Benjamin S, AU - Jallo,George I, Y1 - 2009/05/06/ PY - 2009/03/26/received PY - 2009/5/7/entrez PY - 2009/5/7/pubmed PY - 2009/10/10/medline SP - 1085 EP - 9 JF - Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery JO - Childs Nerv Syst VL - 25 IS - 9 N2 - BACKGROUND: Cord retethering and other postoperative complications can occur after the surgical untethering of a first-time symptomatic tethered cord. It is unclear if using duraplasty vs. primary dural closure in the initial operation is associated with decreased incidence of either immediate postoperative complications or subsequent symptomatic retethering. It is also unclear if different etiologies are associated with different outcomes after each method of closure. We reviewed our pediatric experience in first-time surgical untethering of symptomatic tethered cord syndrome (TCS) to identify the incidence of postoperative complications and symptomatic retethering after duraplasty vs. primary closure. MATERIALS AND METHODS: We retrospectively reviewed 110 consecutive pediatric (<18 years old) cases of first-time symptomatic spinal cord untethering at our institution over a 10-year period. Incidence of postoperative complications and symptomatic retethering were compared in cases with duraplasty vs. primary dural closure use. RESULTS: Mean age was 5.7 +/- 4.8 years old. "Complex" etiologies included lipomyelomeningocele or prior lipomyelomeningocele repair in 22 (20%) patients, prior myelomeningocele repair in 35 (32%), and concurrent lumbosacral lipoma in 18 (16%). "Noncomplex etiologies" included fatty filum in 26 (24%) and split cord malformation in five (4%). Seventy-five (68%) cases underwent primary dural closure vs. 35 (32%) with duraplasty. Twenty-nine (26%) patients experienced symptomatic retethering at a median [interquartile range (IQR)] of 30.5 [20.75-41.75] months postoperatively. There was no difference in incidence of postoperative cerebrospinal fluid leak, surgical site infection, or median [IQR] length of stay in patients receiving primary dural closure [4 (5%), 7 (9%), and 5 (4-6) days, respectively] vs. duraplasty [3 (9%), 3 (9%), and 6 [5-8] days, respectively], p > 0.05. Complex etiologies were more likely to retether than noncomplex etiologies after primary closure (33.6% vs. 6.6%, p = 0.05) but not after duraplasty (13.7% vs. 5.4%, p = 0.33). Duraplasty graft type (polytetrafluoroethylene vs. bovine pericardium) was not associated with pseudomeningocele or retethering. CONCLUSION: In our experience, the increased rate of symptomatic retethering observed with complex pediatric TCS (pTCS) etiologies after primary dural closures was not observed when duraplasty was instituted. Expansile duraplasty may be valuable specifically in the management of patient subgroups with complex pTCS etiologies. SN - 1433-0350 UR - https://www.unboundmedicine.com/medline/citation/19418057/Incidence_of_symptomatic_retethering_after_surgical_management_of_pediatric_tethered_cord_syndrome_with_or_without_duraplasty_ L2 - https://doi.org/10.1007/s00381-009-0895-6 DB - PRIME DP - Unbound Medicine ER -