Disparities in Indications and Outcomes Reporting for Pediatric Tethered Cord Surgery: The Need for a Standardized Outcome Assessment Tool

Sunday, May 5, 2024

3:47 PM – 3:49 PM CT

Location: S405b

Presenting Author(s)

VR

Vijay M. Ravindra, MD, MSPH

Pediatric Neurosurgeon
Naval Medical Center San Diego
San Diego, CA, US

Co-Author(s)

Matt Findlay, n/a

Medical Student
University of Utah
Salt Lake City, UT, US

Co-Author(s)

Douglas Brockmeyer, MD (he/him/his)

Residency Director
University of Utah
Salt Lake City, Utah, United States
DG

David Gonda, MD

Rady Children's Hospital
San Diego, California, United States
Rajiv R. Iyer, MD

Physician
University of Utah
Salt Lake City, Utah, United States
MK

Michael P. Kelly, MD

Rady Children's Hospital
Saskatoon, Saskatchewan, Canada
John R.W. Kestle, MD

University of Utah
Salt Lake City, UT, US
ST

Sam Tenhoeve, BA

Medical Student
University of Utah
Salt Lake City, Utah, United States
ST

Skyler Terry

University of Utah, United States

Disclosure(s):

Matt Findlay, n/a: No financial relationships to disclose

John R.W. Kestle, MD: No financial relationships to disclose

Vijay M. Ravindra, MD, MSPH: No financial relationships to disclose

Introduction: Tethered cord syndrome (TCS) is characterized by abnormal attachment of the spinal cord neural elements to surrounding tissues. The most common symptoms include pain, motor or sensory dysfunction, and urologic deficits. Although TCS is common in children, there is significant heterogeneity in outcomes reporting. We sought to systematically review surgical indications and postoperative outcomes to assess the need for a grading/classification system.

Methods: PubMed and EMBASE searches captured pediatric TCS literature published between 1950 and 2023. Studies reporting surgical interventions, minimum 6-month follow-up, and ≥5 patients were included.

Results: Fifty-five studies representing 3798 patients were included. The most commonly reported non-urologic symptoms were nonspecific lower-extremity motor disturbances (36.4% of studies), lower-extremity/back pain (32.7%), nonspecific lower-extremity sensory disturbances (29.1%), gait abnormalities (29.1%), and nonspecific bowel dysfunction/fecal incontinence (25.5%). Urologic symptoms were most commonly reported as nonspecific complaints (40.0%). After detethering surgery, retethering was the most widely reported non-urologic outcome (40.0%), followed by nonspecific motor deficits (32.7%), nonspecific lower-extremity/back/perianal pain (18.2%), nonspecific gait/ambulation function (18.2%), nonspecific sensory deficits (12.7%), and nonspecific bowel deficits/fecal incontinence (12.7%). Commonly reported urologic outcomes included nonspecific bladder/urinary deficits (27.3%), bladder capacity (20.0%), bladder compliance (18.2%), urinary incontinence/enuresis/neurogenic bladder (18.2%), and nonspecific urodynamics/urodynamics score change (16.4%).

Conclusion : TCS surgical literature is highly variable regarding surgical indications and reporting of postsurgical outcomes. The lack of common data elements and consistent quantitative measures inhibits higher-level analysis. The development and validation of a standardized outcomes measurement tool – ideally encompassing both patient reported outcome measures and objective measures would significantly benefit future TCS research and surgical management.