Authors: Ethan Cottrill; U. Kumar Kakarla, MD; Samuel Kalb, MD; Corinna Zygourakis, MD; A. Karim Ahmed, BS; Zachary Pennington, BS; Alexander Perdomo-Pantoja, MD; Wataru Ishida, MD; Daniel Sciubba, MD; Timothy Witham, MD; Mari Groves, MD; Nicholas Theodore, MD (Baltimore, MD)

Introduction:

There remains limited data on the safety and efficacy of posterior vertebral column subtraction osteotomy (PVCSO) for the treatment of tethered cord syndrome (TCS). The purpose of this prospective study was to evaluate surgical outcomes following PVCSO in adult patients with a history of failed detethering surgery caused by lipomyelomeningocele.

Methods:

From January 2011 to October 2018, select patients were enrolled and treated with PVCSO at Barrow Neurological Institute and The Johns Hopkins Hospital. Inclusion criteria for surgery were age 18 years and greater, TCS caused by lipomyelomeningocele, history of failed detethering surgery, recurrent symptom progression less than 2 years, and treatment willingness. Herein, all patients undergoing surgery with a one-month minimum follow-up were evaluated.

Results:

Twenty patients (mean age: 36 years; sex: 5M/15F) met the inclusion criteria and were evaluated. The average number of previous detethering procedures was 3.7 (range: 1-17). The most common presenting symptom was back pain (95%), followed by urinary incontinence (80%), leg pain (75%), fecal incontinence (55%), sensory abnormalities (50%), and motor deficits (50%). At an average follow-up of 11.2 months (range: 1.8-26 months), symptomatic improvement/resolution was most notable for leg pain (93%), followed by back pain (84%), sensory abnormalities (80%), motor deficits (80%), fecal incontinence (55%), and urinary incontinence (50%). Oswestry Disability Index improved significantly from a mean of 56.1 pre-operatively to 38.4 at end follow-up (p=0.006). The mean spinal column height reduction was 23.7 mm (range: 18-28 mm). Three complications were noted, one each for durotomy, wound infection requiring debridement, and new sensory abnormality.

Conclusion:

We report the first prospective study on the safety and efficacy of PVCSO in 20 adult patients with a history of failed detethering surgery caused by lipomyelomeningocele. Our results suggest that PVCSO is an attractive alternative, extradural approach that may afford definitive treatment in this subpopulation.