Is detethering necessary before deformity correction in congenital scoliosis associated with tethered cord syndrome: a meta-analysis of current evidence

Abstract

Purpose To compare the clinical and radiological outcomes in patients with congenital scoliosis (CS) and tethered cord syndrome (TCS) undergoing deformity correction with (NI group) versus without (NNI group) prior neurosurgical intervention aimed at detethering the cord. Methods A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until March 2020. Inclusion criteria was studied describing performance of deformity correction and fusion surgery for congenital scoliosis with tethered cord syndrome with or without prior detethering procedure. Studies describing growth sparing procedures or congenital scoliosis associated with non-tethering pathologies such as syrinx were excluded. Case reports and series with less than 10 subjects were also excluded. NIH quality assessment tool was used for assessing quality of individual study. Results Sixteen studies were included for analysis of which eight were found to be retrospective case series (level IV evidence) and retrospective case-control studies (level III evidence) each. Overall proportional meta-analysis found no significant difference in correction rate, operative duration, blood loss or complication rate between the NI and NNI groups. However, subgroup analysis performed after inclusion of only level III evidence studies revealed significantly lesser operative duration and blood loss with comparable correction and complication rate in NNI group. Conclusion Deformity correction and fusion surgery may be performed safely and effectively in CS with TCS patients without the need of a prior detethering procedure.

Is Final Fusion Necessary for Growing-Rod Graduates: A Systematic Review and Meta-Analysis

“…1,2 Both the implants need to be anchored to the proximal and distal fixation points usually constituted by 2 vertebrae cranially between T2 to T4 and 2 vertebrae caudally, usually the stable or the last touch vertebra. [3][4][5][6] Sub-periosteal dissection is avoided in the segments lying in between the cranial and caudal fixation points to maintain the growth potential in these segments and periodic distractions achieve the necessary lengthening of the trunk.…”

Depth Vision-Based Assessment of Bone Marrow Mesenchymal Stem Cell Differentiation Capacity in Patients with Congenital Scoliosis

“…These genes are all related to the NOTCH signaling pathway, which plays an important role in organogenesis, development, and apoptosis during the early development of various tissues and organs. Osteogenesis within the cartilage is significantly restricted [ 9 – 11 ]. The study of SCD, a genetic disease with spinal deformity, provided important information on the genetic pattern of CS, suggesting that these genes play an important role in the normal development of the spine.…”

Concave Side Apical Control in Early Onset Scoliosis Managed with Growing Rods

“…[1,2] These implants require to be anchored to the cranial and caudal fixation sites commonly formed by two vertebrae proximally and two vertebrae distally, and intermittent distractions attain the required lengthening of the body. [3][4][5][6] TGRs were commonly applied in severe cases of EOS during the last decades but required periodic operative distraction under general anesthesia associated with comparatively elevated rates of infection. [7,8] MCGRs were presented approximately 10 years ago and were first published in 2012.…”