Dataset Information

Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis.

ABSTRACT:

Background

Few have explored the safety and efficacy of posterior vertebral column subtraction osteotomy (PVCSO) to treat tethered cord syndrome (TCS).

Objective

To evaluate surgical outcomes after PVCSO in adults with TCS caused by lipomyelomeningocele, who had undergone a previous detethering procedure(s) that ultimately failed.

Methods

This is a multicenter, retrospective analysis of a prospectively collected cohort. Patients were prospectively enrolled and treated with PVCSO at 2 institutions between January 1, 2011 and December 31, 2018. Inclusion criteria were age ≥18 yr, TCS caused by lipomyelomeningocele, previous detethering surgery, and recurrent symptom progression of less than 2-yr duration. All patients undergoing surgery with a 1-yr minimum follow-up were evaluated.

Results

A total of 20 patients (mean age: 36 yr; sex: 15F/5M) met inclusion criteria and were evaluated. At follow-up (mean: 23.3 ± 7.4 mo), symptomatic improvement/resolution was seen in 93% of patients with leg pain, 84% in back pain, 80% in sensory abnormalities, 80% in motor deficits, 55% in bowel incontinence, and 50% in urinary incontinence. Oswestry Disability Index improved from a preoperative mean of 57.7 to 36.6 at last follow-up (P < .01). Mean spinal column height reduction was 23.4 ± 2.7 mm. Four complications occurred: intraoperative durotomy (no reoperation), wound infection, instrumentation failure requiring revision, and new sensory abnormality.

Conclusion

This is the largest study to date assessing the safety and efficacy of PVCSO in adults with TCS caused by lipomyelomeningocele and prior failed detethering. We found PVCSO to be an excellent extradural approach that may afford definitive treatment in this particularly challenging population.

SUBMITTER: Theodore N

PROVIDER: S-EPMC7884146 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background:Conventional anterior cervical corpectomy and fusion (ACCF) for cervical ossification of the posterior longitudinal ligament (OPLL) is associated with a high incidence of surgery-related complications. A novel anterior decompression technique [vertebral body sliding osteotomy (VBSO)] has been developed to prevent such complications and achieve effective anterior decompression for severe OPLL patients. The purpose of this study was to describe the procedure of novel surgical technique and to evaluate the long-term surgical outcomes. Methods:Between 2012 and 2014, 24 patients underwent VBSO for treatment of cervical myelopathy caused by severe OPLL. Operation time, estimated blood loss (EBL), neurologic outcomes and perioperative complications were investigated. Various radiographic parameters such as the preoperative canal occupying ratio, postoperative canal widening, and preoperative and postoperative cervical sagittal alignment were also measured. Minimum follow-up was 24 months. Results:The mean Japanese Orthopaedic Association score for cervical myelopathy (C-JOA score) improved from 12.4±2.9 preoperatively to 16.0±1.4 at the final follow-up (P<0.05). The mean recovery rate of the C-JOA score at the final follow-up was 68.65%±17.80%. The mean operating time was 130.7±21.0 minutes and the EBL was 176.3±38.0 mL. There were no perioperative complications. Pseudarthrosis was detected in two cases at 12 months postoperatively. The average spinal canal compromised ratio by OPLL decreased from 64.0%±15.0% preoperatively to 15.5%±12.2% postoperatively (P<0.05), with an average postoperative canal widening of 5.15±1.39 mm. Conclusions:Novel anterior decompression technique termed VBSO may be an effective and safe surgical option for anterior decompression surgery in patients with severe cervical OPLL. Since, VBSO does not involve a direct manipulation of the OPLL mass or dissection of the interspace between the OPLL and dura mater, this may significantly decrease the incidence of surgery-related complications, operation time, and intraoperative blood loss.