Response of Scoliosis in Children with Myelomeningocele to Surgical Release of Tethered Spinal Cord

Abstract

Objective:To examine the effect of surgical tethered cord release (TCR) on scoliosis in children with myelomeningocele. Methods: A retrospective review of 65 pediatric patients with myelomeningocele and TCR. The final sample consisted of 20 patients with scoliosis who were managed conservatively after TCR. Results: Average age at TCR was 6.2 years with average follow-up of 3.8 years. Scoliosis of 1 (5%) patient improved, 7 (35%) were stable, and 12 (60%) worsened (≥10°). Fifty percent of patients ultimately required definitive spinal surgery. TCR release delayed definitive spine surgery for an average of 3.2 years. Sixty-four percent of patients with curves less than or equal to 45° had progression of their curves compared to 50% with curves greater than 45°. For patients with curves less than or equal to 45°, curves progressed in 80% of those younger than 10 years as compared to 25% of those older than 10 years. For patients with curves less than or equal to 45°, 43% required definitive spine surgery as opposed to 83% with curves greater than 45°. Level of neurological involvement (ie, lumbar versus thoracic) and age at untethering emerged as factors influencing the effects of TCR for patients with curves less than or equal to 45°. Lumbar curves had more favorable results. Conclusion: Pediatric patients with myelomeningocele and scoliosis should be closely assessed and monitored. A selective approach for youth with lumbosacral level myelomeningocele and progressive curves less than or equal to 45° may result in scoliosis stabilization and avoidance of definitive surgery.

Orthopedic management of myelomeningocele with a multidisciplinary approach: a systematic review of the literature

“…✓From the 26 articles included, 19 were retrospective cohorts [ 9 – 14 , 20 , 21 , 41 – 45 , 49 , 51 , 54 – 57 ], 4 were prospective cohorts [ 26 , 46 , 52 , 53 ], 2 were retrospective cross-sectional studies [ 47 , 48 ], and 1 was a case-control study [ 50 ]. We systematically reviewed clinical management of 229,791 patients with MMC whose treatment involved at least one kind of orthopedic intervention.…”

“…We systematically reviewed clinical management of 229,791 patients with MMC whose treatment involved at least one kind of orthopedic intervention. Sixteen studies provided other types of managements, besides orthopedic approaches, which were as follows: 11 (42.31%) urologic management [ 9 – 11 , 44 , 45 , 50 , 51 , 53 , 55 – 57 ], 13 (50%) neurosurgical management [ 9 – 11 , 20 , 43 – 45 , 49 , 50 , 53 , 55 – 57 ], 11 (42.31%) neurologic management [ 9 – 11 , 21 , 44 , 45 , 49 , 53 , 55 – 57 ], and 5 (19.23%) gastrointestinal management [ 9 , 11 , 55 – 57 ]. Moreover, all the studies included described postnatal operations and management.…”

“…Ten out of the 26 included studies included corrective operations of the spine related to scoliosis in 5 studies [ 10 , 13 , 21 , 43 , 51 ], kyphosis in 3 studies [ 20 , 21 , 47 ], and lumbar lordosis in 2 studies [ 20 , 21 ].…”

“…Altiok et al performed tethered cord release surgery (TCR) before scoliosis surgery. The average Cobb angle improved from 68.4° ± 21.8° before TCR to 44.5° ± 16.6° after corrective spine surgery [ 51 ]. Ryabykh et al reviewed the outcome of instrumented fusion by pedicle screw-rod constructs in 20 patients.…”

“…Sixteen studies [ 9 – 12 , 20 , 21 , 43 – 45 , 49 – 51 , 53 , 55 – 57 ] had used managements other than orthopedic, including urologic, neurosurgical, neurologic, and gastrointestinal managements.…”