Vertebral Column Resection for Recurrent Tethered Cord: A 10-Year Single-Institution Case Series

Introduction: Tethered cord syndrome (TCS) is a condition causing sensorimotor deficits and incontinence that impairs functional independence. Detethering procedures are associated with high rates of retethering, requiring repeat surgeries. Spine shortening via vertebral column resection (VCR) is an alternative treatment option for select patients, however, series describing the technique are sparse and lack long term follow-up. Here we present one of the largest series to date and the first including pediatric patients, reporting outcomes of VCR for recurrent TCS.

Methods: Consecutive patients who underwent VCR from 2014 to 2023 at a single institution were retrospectively identified. Clinical and demographic factors were recorded including primary diagnosis and presenting symptoms. Pre- and postoperative imaging were reviewed to determine vertebral column height reduction. Operative complications and neurological status at latest follow up were recorded, as well as health-related quality of life as determined by EQ-5D scores. Pre- and post-postoperative symptoms and EQ-5D scores were compared.

Results: Seventeen patients (10 male; 58.8%) with a median age of 19 (range 10 - 68) were included. Four patients were excluded due to lack of complete follow-up information. The most common etiology of tether was lipomyelomeningocele (n=15; 88.2%). Mean number of previous detetherings was 2.8 + 2. Symptom resolution at mean follow up of 32.1 + 24 months was observed in 11 patients (100%) with back pain, 4 patients (100%) with fecal incontinence, 4 patients (50%) with urinary incontinence, 8 patients (66.6%) with leg pain or numbness, and 9 patients (81.9%) with lower extremity motor deficit. Eleven patients (64.7%) experienced improvements in EQ-5D scores postoperatively. Mean spinal column height reduction was 16.8 + 4 mm. Complications included CSF leak in one case and intraoperative blood loss > 2L in 3 cases.

Conclusion : VCR for patients with recurrent TCS is a well-tolerated treatment option associated with a high rate of symptomatic improvement.