Functional Outcomes in Children With Myelomeningocele Following Orthopedic Scoliosis Correction With or Without Prior Spinal Cord Untethering
En'Wezoh, Derick C.
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CitationEn'Wezoh, Derick C. 2016. Functional Outcomes in Children With Myelomeningocele Following Orthopedic Scoliosis Correction With or Without Prior Spinal Cord Untethering. Doctoral dissertation, Harvard Medical School.
AbstractPurpose: Patients with surgically corrected myelomeningocele have a distally anchored spinal cord. These patients are predisposed to developing progressive scoliosis, often requiring surgery for curve correction and spinal fusion. Some authors have advocated prophylactic spinal cord untethering prior to corrective spine surgery to protect the tethered cord from injury. The purpose of this study was to identify any functional benefit from spinal cord untethering in otherwise asymptomatic myelomeningocele patients prior to corrective spinal surgery.
Methods: We retrospectively identified 45 patients who had corrective spinal surgery at Boston Children’s Hospital between 1990 and 2011 who met the inclusion criteria. The patients were analyzed in two ways. 1) Pre- and post- fusion functional status of those who had an untethering operation at the time of or within the 6 months prior to spinal fusion (UT < 6m, 10 patients) was compared to that of those who were not untethered during this six-month period (NUT < 6m, 35 patients). 2) Pre- and post- fusion functional status of those who had an untethering operation at any time prior to spinal fusion (UT anytime, 25 patients) were compared to those who had never been untethered (NUT anytime, 20 patients). We collected demographic, radiographic, and pre/post-fusion functional status data for each patient from medical record review. Functional status was quantified using the Necker-Enfants Malades (NEM) and modified Hoffer scoring systems. Spine radiographs were available for measurement of pre- and post-operative curve severity in 33 patients (20 UT, 13 NUT).
Results: For those with available radiographs, the average scoliotic curvature was 83 degrees pre-operatively and 22.3 degrees post-operatively for an average correction of 73% (73% for those who had been previously untethered and 71% for those who had never been untethered). In the first analysis, the mean change in NEM scores following fusion was +0.2 and +0.06 for the UT and NUT groups, respectively (p=0.71); and, mean change in Hoffer score was -0.2 and +0.06 for UT and NUT groups, respectively (p=0.13). In the second analysis, the mean change in NEM following fusion was +0.24 and +1.17 for the UT and NUT groups, respectively (p=0.29); and, mean change in Hoffer score was +0.65 and +0.00 for the UT and NUT groups, respectively (p=1.00).
Conclusions: This retrospective study was unable to identify any advantage of recent or remote spinal cord untethering in regard to overall functional outcome following corrective spinal surgery in MM patients.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:40620244