Muñoz Andrea M, Alvandi Leila M, Gjonbalaj Edina, Morris Allyn, Sponseller Paul, Anderson Richard C E, Gomez Jaime A
Department of Orthopaedic Surgery, Division of Pediatric Orthopaedic Surgery, Montefiore Einstein, Bronx.
Department of Orthopaedic Surgery, John Hopkins University, Baltimore, MD.
J Pediatr Orthop. 2025 Apr 1;45(4):e352-e357. doi: 10.1097/BPO.0000000000002883. Epub 2024 Dec 24.
Congenital early onset scoliosis (C-EOS) often co-occurs with tethered spinal cord syndrome (TSCS), necessitating surgical intervention to address both conditions to prevent worsening neuromuscular function. Detethering can be done concurrently with spinal deformity correction (SDC), before SDC, or not done at all. This study explores perioperative complications in C-EOS patients with and without TSCS who underwent SDC with growing instrumentation or fusion. We hypothesize that C-EOS patients with a history of TSCS who underwent SDC with either growing instrumentation or fusion experienced higher rates of perioperative complications compared with those without TSCS. Among patients with a history of TSCS, we hypothesize that those who were detethered had fewer perioperative complications than those who were not detethered.
Data from 751 C-EOS patients from an international spine registry were reviewed. After applying inclusion and exclusion criteria, 477 patients were divided into groups: those with TSCS (n=90) and those without (n=387). Among TSCS patients, the majority underwent detethering (n=54), whereas 36 did not. Demographics, magnetic resonance imaging (MRI) findings, treatment history, and surgical complications were assessed. Statistical analyses were conducted to compare demographic and clinical parameters, including complication rates, using appropriate tests. Postoperative complications were further categorized according to the modified Clavien-Dindo-Sink (mCDS) classification system.
Comparing C-EOS patients with and without TSCS revealed no significant differences in age at first MRI ( P =0.52), pre-index major coronal curve ( P =0.43), pre-index maximum sagittal kyphosis ( P =0.113), the number of growth-friendly procedures ( P =1.00), resection ( P =0.071), osteotomy ( P =0.081), intraoperative complications ( P =0.088), postoperative complications ( P =0.41), hardware failure ( P =0.78), infections ( P =0.26), and neurological complications ( P =0.42). Postoperative complications further categorized using the mCDS demonstrated no significant differences between the groups ( P =0.144). No significant differences were found in age at first MRI ( P =0.60), pre-index major coronal curve ( P =0.90), pre-index maximum sagittal kyphosis ( P =0.50), resection ( P =0.20), or osteotomy ( P =0.47) between the detethered and not detethered cohorts. However, a higher percentage of TSCS patients without detethering underwent a growth-friendly procedure ( P =0.003). In addition, TSCS patients without detethering experienced higher rates of postoperative complications ( P =0.009), hardware failure ( P =0.005), and infections ( P =0.031) compared with those who underwent detethering. No differences were noted for intraoperative ( P =0.059) or neurological ( P =0.190) complications based on detethering status. Similarly, postoperative complications using the mCDS revealed that patients who were not detethered had higher rates of complications ( P =0.017).
Although there were no significant differences between C-EOS patients with and without TSCS, this study underscores the importance of detethering in C-EOS patients with concurrent TSCS. Detethering significantly reduced the risk of postoperative complications, hardware failure, and infection after SDC with growing instrumentation or fusion. However, given that the not detethered group had a higher frequency of growth-friendly procedures, these findings should be interpreted with caution. These findings highlight the potential benefits of detethering in improving surgical outcomes for C-EOS patients undergoing SDC with growing instrumentation or fusion.
III.
先天性早发性脊柱侧凸（C-EOS）常与脊髓拴系综合征（TSCS）同时出现，因此需要进行手术干预以解决这两种情况，防止神经肌肉功能恶化。脊髓松解术可以与脊柱畸形矫正（SDC）同时进行、在SDC之前进行，或者根本不进行。本研究探讨了接受生长棒器械植入或融合术的SDC的伴有或不伴有TSCS的C-EOS患者的围手术期并发症。我们假设，与没有TSCS病史的患者相比，有TSCS病史且接受生长棒器械植入或融合术的SDC的C-EOS患者围手术期并发症发生率更高。在有TSCS病史的患者中，我们假设接受脊髓松解术的患者比未接受脊髓松解术的患者围手术期并发症更少。
回顾了来自一个国际脊柱登记处的751例C-EOS患者的数据。应用纳入和排除标准后，477例患者被分为两组：有TSCS的患者（n=90）和没有TSCS的患者（n=387）。在有TSCS的患者中，大多数接受了脊髓松解术（n=54），而36例未接受。评估了人口统计学、磁共振成像（MRI）结果、治疗史和手术并发症。进行统计分析以比较人口统计学和临床参数，包括并发症发生率，使用适当的检验方法。术后并发症根据改良的Clavien-Dindo-Sink（mCDS）分类系统进一步分类。
比较有和没有TSCS的C-EOS患者发现，首次MRI检查时的年龄（P=0.52）、索引前主要冠状面弯曲度（P=0.43）、索引前最大矢状面后凸度（P=0.113）、生长友好型手术的数量（P=1.00）、切除术（P=0.071）、截骨术（P=0.081）、术中并发症（P=0.088）、术后并发症（P=0.41）、内固定失败（P=0.78）、感染（P=0.26）和神经并发症（P=0.42）方面均无显著差异。使用mCDS进一步分类的术后并发症在两组之间也无显著差异（P=0.144）。在接受脊髓松解术和未接受脊髓松解术的队列之间，首次MRI检查时的年龄（P=0.60）、索引前主要冠状面弯曲度（P=0.90）、索引前最大矢状面后凸度（P=0.50）、切除术（P=0.20）或截骨术（P=0.47）均无显著差异。然而，未接受脊髓松解术的TSCS患者接受生长友好型手术的比例更高（P=0.003）。此外，与接受脊髓松解术的患者相比，未接受脊髓松解术的TSCS患者术后并发症发生率更高（P=0.009）、内固定失败率更高（P=0.005）、感染率更高（P=0.031）。基于脊髓松解术状态，术中（P=0.059）或神经（P=0.190）并发症无差异。同样，使用mCDS的术后并发症显示，未接受脊髓松解术的患者并发症发生率更高（P=0.017）。
虽然有和没有TSCS的C-EOS患者之间没有显著差异，但本研究强调了脊髓松解术在伴有TSCS的C-EOS患者中的重要性。脊髓松解术显著降低了接受生长棒器械植入或融合术的SDC术后并发症、内固定失败和感染的风险。然而，鉴于未接受脊髓松解术的组生长友好型手术的频率更高，这些发现应谨慎解释。这些发现突出了脊髓松解术在改善接受生长棒器械植入或融合术的SDC的C-EOS患者手术结果方面的潜在益处。
III级。
