Trends in the presentation, surgical treatment, and outcomes of tethered cord syndrome: A nationwide study from 2001 to 2010

Cyrus M Jalai; Charles Wang; Bryan J Marascalchi; Samantha R Horn; Gregory W Poorman; Olivia J Bono; Anthony K Frempong-Boadu; Peter G Passias

doi:10.1016/j.jocn.2017.03.034

Trends in the presentation, surgical treatment, and outcomes of tethered cord syndrome: A nationwide study from 2001 to 2010

J Clin Neurosci. 2017 Jul:41:92-97. doi: 10.1016/j.jocn.2017.03.034. Epub 2017 Mar 22.

Authors

Cyrus M Jalai¹, Charles Wang², Bryan J Marascalchi³, Samantha R Horn¹, Gregory W Poorman¹, Olivia J Bono¹, Anthony K Frempong-Boadu⁴, Peter G Passias⁵

Affiliations

¹ Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA.
² Eastern Virginia Medical School, Norfolk, VA, USA.
³ Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, MD, USA.
⁴ Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA.
⁵ NY Spine Institute/Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA. Electronic address: Peter.Passias@nyumc.org.

PMID: 28342704
DOI: 10.1016/j.jocn.2017.03.034

Abstract

Objective: This is a nationwide query into surgical management techniques for tethered cord syndrome, focusing on patient demographic, hospital characteristics, and treatment outcomes. Our hypothesis is that detethering vs. fusion for TCS results in different in-hospital complications.

Materials and methods: Retrospective review of the Nationwide Inpatient Sample 2001-2010. Inclusion: TCS discharges undergoing detethering or fusion. Sub-analysis compared TCS cases by age (pediatric [≤9years] vs. adolescent [10-18year]). Independent t-tests identified differences between fusion and detethering for hospital-related and surgical factors; multivariate analysis investigated procedure as a risk factor for complications/mortality.

Results: 6457 TCS discharges: 5844 detetherings, 613 fusions. Fusion TCS had higher baseline Deyo Index (0.16 vs. 0.06), procedure-related complications (21.3% vs. 7.63%), and mortality (0.33% vs. 0.09%) than detethering, all p<0.001. Detethering for TCS was a significant factor for reducing mortality (OR 0.195, p<0.001), cardiac (OR 0.27, p<0.001), respiratory (OR 0.26, p<0.001), digestive system (OR 0.32, p<0.001), puncture nerve/vessel (OR 0.56, p=0.009), wound (OR 0.25, p<0.001), infection (OR 0.29, p<0.001), posthemorrhagic anemia (OR 0.04, p=0.002), ARDS (OR 0.13, p<0.001), and venous thrombotic (OR 0.53, p=0.043) complications. Detethering increased nervous system (OR 1.34, p=0.049) and urinary (OR 2.60, p<0.001) complications. Adolescent TCS had higher Deyo score (0.08 vs. 0.03, p<0.001), LOS (5.77 vs. 4.13days, p<0.001), and charges ($54,592.28 vs. $33,043.83, p<0.001), but similar mortality. Adolescent TCS discharges had increased prevalence of all procedure-related complications, and higher overall complication rate (11.10% vs. 5.08%, p<0.001) than pediatric.

Conclusions: With fusion identified as a significant risk factor for mortality and multiple procedure-related complications in TCS surgical patients, this study could aid surgeons in counseling TCS patients to optimize outcomes.

Keywords: Detethering vs. fusion; In-hospital complications; Surgical management; Tethered cord syndrome.

MeSH terms

Adolescent
Adult
Aged
Child
Child, Preschool
Female
Humans
Infant
Inpatients / statistics & numerical data
Male
Middle Aged
Neural Tube Defects / diagnosis
Neural Tube Defects / epidemiology*
Neural Tube Defects / surgery
Patient Discharge / statistics & numerical data
Risk Factors
Treatment Outcome