216. Secondary Tethered Cord in Children with Spinal Dysraphism: Outcomes with Surgical Untethering

Authors: Greg Olavarria, MD, FAANS; Austin Kennedy (Orlando, FL)

Introduction:

Children with spinal cord untethering surgery on one center are presented, and symptom presentation and outcomes tracked.  We measured impact of surgery on symptom presentation, and compared patients with single and multiple surgeries.  Our hypothesis was that pain, motor, and bladder function would improve in children after surgery, but multiple surgeries might incur deficits.

Methods:

53 children met inclusion under 21 yrs, operated between 2005 to 2015.  Follow up conducted in our multi-disciplinary spinal dysraphism clinic, with at least one year follow up.  Symptom presentation (pain, motor function, bladder function) tracked and analysis of outcomes based on stability, improvement, and worsening.  Avg age 11 yrs, functional levels were thoracic or high lumbar (L1 to 4) in 21 (40%), low lumbar or sacral in 32 (60%).  Myelomeningocele in 38 (72%), and lipomyelomeningocele or myelocystocele in 15 (28%). 4 children had scoliosis (7%).    

Results:

53 pts total, 23 patients had one surgery (43%), 30 had two or more (57%), for 110 procedures. 49 patients or 92% presented with back or leg pain, and 32 (65%) of these had long term relief, 15 (31%) stable, and in 2 (4%) worsened.  For children presenting with pain, multiple surgery had significantly less relief.  25 or 47% presented with complaint of motor weakness and of those 6 (24%) improved, 14 (56%) stabilized, 5 (20%) had worse function postop. No difference in motor or urinary function between one and multiple surgery groups.  Complication rate was 10%.      

Conclusion:

Surgery for secondary tethering can lead to improvement in pain, and motor function can improve but stability was more common.  Multiple surgeries did not seem to incur deterioration, but pain relief diminished. We present our findings in light of existing literature, which demonstrate variable results, and no recent large series exist. A management algorithm will be presented.