Increased complications without neurological benefit are associated with prophylactic spinal cord untethering prior to scoliosis surgery in children with myelomeningocele

Goldstein, Hannah; Shao, Belinda; Madsen, Peter J; Hartnett, Sara; Blount, Jeffrey P.; Brockmeyer, Douglas L.; Campbell, Robert M.; Conklin, Michael; Hankinson, Todd C.; Heuer, Gregory G.; Jea, Andrew; Kennedy, Benjamin C.; Tuite, Gerald F.; Rodríguez, L. F.; Feldstein, Neil A.; Vitale, Michael G.; Anderson, Richard C. E.

doi:10.1007/s00381-019-04276-z

Cited by 9 publications

(8 citation statements)

References 24 publications

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“…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 ].…”

Section: Resultsmentioning

confidence: 99%

“…They found an increased risk of complications, including surgical site infection (adjusted RR = 2.65, p = 0.02), rate of return to operation room (adjusted RR = 2.17, p = 0.045), the need for blood transfusion ( p = 0.04), and increased mean length of stay ( p < 0.0001). Moreover, they stated no increased risk of neurological injury without prophylactic untethering before scoliosis surgery in MMC patients [ 10 ].…”

Section: Resultsmentioning

confidence: 99%

“…Despite releasing untethered cord procedures, Altiok et al reported bladder control impairment [ 51 ]. According to the study by Goldstein et al, prophylactic spinal cord untethering before scoliosis correction surgeries improved the urologic function of 1% of the MMC patients, which is not promising [ 10 ]. Sileo et al indicated postnatal surgical repairs on neonates with MMC, 10.9% of whom were diagnosed with hydronephrosis at the follow-up, and 81.8% with a neuropathic bladder [ 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…Orthopedic consequences may arise from MMC involving various parts of the body, including feet, spine, and hip [ 9 , 10 ]. Several orthopedic methods are used to manage these disabilities with variable success [ 11 – 14 ], and we will give a brief introduction regarding them in this “Background” section.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background Myelomeningocele (MMC) is the most common and severe form of spina bifida and imposes a significant burden on patients and the healthcare system. Recently, the multidisciplinary management of MMC has become popular. Herein, we aimed to review the orthopedic management, outcomes, and complications of the of patients with MMC eyeing a multidisciplinary approach. Methods We searched PubMed and EMBASE to find relevant studies published before August 2020. All studies that included clinical management of MMC patients and published earlier than 2000 were considered for review on the condition that they reported at least one orthopedic intervention and the rate of complications. We excluded review articles, case reports, case series, letters, commentaries, editorials, and conference abstracts. The primary and secondary goals of our review were to report the outcomes and complication rates of multidisciplinary management for MMC patients. Results Twenty-six studies included data for the management of 229,791 patients with MMC and were selected. Sixteen studies reported multidisciplinary management in addition to orthopedic management. From those, 11 (42.31%) included urologic management, 13 (50%) neurosurgical management, 11 (42.31%) neurologic management, and 5 (19.23%) gastrointestinal management. All studies included postnatal operations and related management. No randomized clinical trial was found in our search. Conclusion Orthopedic approaches play a key role in MMC management by alleviating spinal deformities, particularly scoliosis, and hip, foot, and ankle complications. However, the most appropriate management, whether surgical or non-surgical, may vary for different patients, given disease severity and the age of patients. Graphical abstract

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…As a result, recognition of such conditions should be carried out before reconstructive surgery. (17)(18)(19) Based on the side of the greater convexity of scoliosis, it can be further subdivided into levoscoliosis and dextroscoliosis. If the convexity of the greater curve of deformity is faced to the right, the condition is known as dextroscoliosis and if it is to the left, the case will be defined as levoscoliosis.…”

Section: Introductionmentioning

confidence: 99%

‘The Association of Scoliosis Properties with Spinal Cord Tethering: A Statistical Model for Prognostication’

Yarandi

Mohammadi

Amirjamshidi

et al. 2022

Preprint

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Objective: To evaluate the relationship between the structural measures of scoliosis and underlying spinal cord tethering (SCT) and proposing a statistical prognostication model. Study design: Cross sectional. Setting: Academic healthcare center Methods: 128 definite scoliosis cases that were candidates for corrective surgery were enrolled. Anterior-posterior whole column digital radiographs and whole-spine MRI (supine for all samples and adjuvant prone MRI for suspected cases with tight filum terminal) were performed. Univariate and multiple logistic regression were used for the analysis of association and interaction. Association of SCT with structural features of scoliosis (Cobb angle, convexity, and type (idiopathic and congenital)), age, and sex were assessed. Results: None of the study variables showed a statistical association with SCT in univariable and multiple logistic regressions. After inclusion of Cobb angle-convexity-type interaction, higher Cobb angle, idiopathic scoliosis, dextrosoliosis, and male gender had a significant effect. Stratification for convexity discovered a positive association of Cobb angle and SCT in idiopathic patients with dextroscoliosis (1.02 [1.01 to 1.03], 0.049). In contrast, in congenital cases, the rate of SCT decreased by higher left-sided Cobb angles but it was not statistically significant (0.94 [0.88 to 1.01], 0.104). Conclusion: The risk of spinal cord tethering was not zero in any of the subgroups and no SCT-free group could be detected. Conventional MRI should be preoperatively performed for every case of scoliosis and thoroughly examined for signs of tethering. Clear imaging of patients at higher risk of SCT should not be decisive and further workup should be utilized before proceeding with reconstructive surgery.

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Myelomeningocele

Karlin

2022

The Growing Spine

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Increased complications without neurological benefit are associated with prophylactic spinal cord untethering prior to scoliosis surgery in children with myelomeningocele

Cited by 9 publications

References 24 publications

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

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

‘The Association of Scoliosis Properties with Spinal Cord Tethering: A Statistical Model for Prognostication’

Myelomeningocele

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