240. Preoperative Spinal Cord Untethering In Children With Spina Bifida Undergoing Thoracolumbar Fusion For Scoliosis

Authors: Britta L. Bureau; Andrew Foy, MD; John Thometz, MD; Eileen Sherburne (Neenah, WI)


Neuromuscular scoliosis is a common long-term consequence of myelomeningocele (MMC). Many MMC patients with progressive scoliosis are treated with thoracolumbar fusion. All children with myelomeningocele have a tethered spinal cord on imaging, raising concern that correction of the scoliosis will lead to neurologic morbidity. It remains unclear if prophylactic spinal cord untethering prior to scoliosis correction is necessary in children with myelomeningocele.


Retrospective, single center chart review of patients with MMC treated with thoracolumbar fusion over the last ten years with or without prophylactic spinal cord untethering.


Seventeen patients with MMC underwent thoracolumbar fusion for scoliosis. Mean age at time of surgery was 13.9 years. Prophylactic spinal cord untethering was performed in 8/17 (47%) patients. The change in Cobb angle after surgery was similar between the two groups (19.4º untethered versus 18.7º no untethering). The ambulatory status was similar between the groups, with 37% of the untethered cohort and 44% of non-untethered cohort being community or household ambulators. There were no changes in intraoperative motor or sensory evoked potential in any patient. No patient had a change in motor level or ambulatory status after scoliosis surgery. 


Our data suggest that prophylactic spinal cord untethering in children with myelomeningocele undergoing thoracolumbar fusion for scoliosis may not be necessary. Our conclusions are limited by the small sample size. A larger review of registry data may yield more powerful conclusions on the necessity of prophylactic spinal cord untethering in this patient population.