A systematic review and meta-analysis of minimally invasive surgery in children with occult tethered cord syndrome

Abstract

Background: At present, the surgical treatment of occult tethered cord syndrome (OTCS) in children is mostly two types of minimally invasive surgery: filum terminalis laxity or filum terminalectomy. The clinical efficacy and safety of minimally invasive treatment and conservative treatment are still unclear. Therefore, this study will use the advantages of systematic review and meta-analysis to evaluate the objectivity, and explore the effect of minimally invasive surgery on children with occult tethered cord syndrome.Methods: A computer search was used to search PubMed, Embase, CNKI, Wanfang Database and other literature search websites about the randomized controlled trials (RCTs) of minimally invasive surgery in children with occult tethered cord syndrome and spinal lipoma. Professional journals were manually searched to avoid omissions. The search keywords were: occult myelolipoma, occult tethered cord syndrome, surgical treatment of tethered cord syndrome, occult tethered cord syndrome.Results: A total of 6 relevant literatures that could be used for meta-analysis were selected. A total of 425 subjects were included in the article, of which 132 were treated conservatively and 293 were treated surgically. The heterogeneity detection test statistics of the included studies were Chi 2 (Chi-squared test) =8.18, df (degree of freedom) =5, I 2 =39%<50%, Z=2.53, and the homogeneity of the included studies was good. The number of unimproved cases under conservative treatment was 40, accounting for 30.30%; the number of unimproved cases under surgical treatment was 33, accounting for 11.26%, and the total unimproved rate of the two groups accounted for 17.17%. The unimproved rate of the experimental group was significantly lower than that of the control group, and the difference was statistically significant (P=0.01).The results of bias analysis showed that there was no significant bias in the literature included in this study.Discussion: Meta-analysis results confirmed that minimally invasive surgery has a significant effect on the treatment of occult children with tethered cord syndrome. However, due to the small sample size of the included literature, further evaluation of the treatment risk is required.

Disparities in indications and outcomes reporting for pediatric tethered cord surgery: The need for a standardized outcome assessment tool

“…The limited commonality among TCS studies is evident in the meta-analyses that have been published to date. For example, in their recently published systematic review and meta-analysis regarding minimally invasive surgery for pediatric occult TCS, Xu et al [ 71 ] were able to include only six studies, with the only consistently reported outcome measure being the postsurgical nonimprovement rate. Notably, they were forced to exclude six eligible studies because of insufficient data for observational indicators regarding nonimprovement description.…”

Comparison of the Inter-laminar Approach and Laminotomy Open Approach for Filum Terminale Lipoma: A Retrospective Analysis

“…In Japan, the universal health insurance system covers prophylactic surgery; historically, many prophylactic resections have been performed. Despite recommendations for prophylactic surgery, this intervention is controversial [13,33]. The standard surgical procedure for FTL is laminotomy-based dissection [9]; however, less-invasive techniques have been reported [8,10,22].…”