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. 2025 May 17;41(1):186.
doi: 10.1007/s00381-025-06837-x.

Association between orthopedic manifestations and tethered cord release in patients with spina bifida: a survival analysis

Anthony M Padgett  1 , Abigail Nishikawa  2 , Jun Kit He  3 , Jeffrey P Blount  4 , Anastasia Arynchyna-Smith  4 , Betsy Hopson  4 , Gerald McGwin  5 , Brandon G Rocque  4 , Michael J Conklin  3
Affiliations

Association between orthopedic manifestations and tethered cord release in patients with spina bifida: a survival analysis

Anthony M Padgett et al. Childs Nerv Syst. .

Abstract

Purpose: Patients with spina bifida (SB) are at risk for symptomatic tethered cord syndrome (TCS). Orthopedic decline, a common manifestation of TCS, is an indication for tethered cord release (TCR). Our objective is to determine if patients with SB who have undergone specific orthopedic operations (release of hip or knee contracture and correction of cavus foot) require TCR at a higher rate than those not undergoing these operations.

Methods: An institutional database was queried to identify all children with SB from 2009 to 2022. Data included functional level of lesion (FLOL), ambulatory status, and diagnosis of myelomeningocele (MMC) vs. closed neural tube defects. Survival analysis was performed to test the association between TCR and index orthopedic operations. Kaplan-Meier survival curves and multivariate Cox proportional hazard models were generated.

Results: There were 659 patients. Thirty-four (5.2%) had a history of orthopedic operation, and 625 (94.8%) had no history of orthopedic operation either before TCR or at last follow-up. Three of thirty-four (8.6%) in the orthopedic group underwent TCR after the orthopedic operation. Two hundred two of six hundred twenty-five (32.3%) in the non-orthopedic group underwent TCR. The adjusted hazard ratio (controlling for FLOL, ambulation, and diagnosis) was 3.8 (95% confidence interval 1.2-11). In MMC, the hazard ratio for the non-orthopedic group compared to the orthopedic group was 5.05 (95% confidence interval 1.2-20.7) which was significant.

Conclusion: Patients with MMC who underwent the specific orthopedic operations were significantly less likely to have subsequent TCR surgery. One possible explanation is that lower extremity deformity correction may alter surgeon behavior regarding TCR.

Keywords: Orthopedic; Spina bifida; Survival; Tethered cord.

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Conflict of interest statement

Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
List of orthopedic surgical procedures recorded in the NSBPR
Fig. 2
Fig. 2
Kaplan–Meier survival curves with time to first tethered cord release among patients with a history of orthopedic intervention (dashed) compared to those with no prior orthopedic operation (solid)
See this image and copyright information in PMC

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References

    1. Au KS, Ashley-Koch A, Northrup H (2010) Epidemiologic and genetic aspects of spina bifida and other neural tube defects. Dev Disabil Res Rev 16(1):6–15. 10.1002/ddrr.93 - PMC - PubMed
    1. Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GN, Shaw GM (2015) Spina bifida Nature Reviews Disease Primers 1:15007. 10.1038/nrdp.2015.7 - PMC - PubMed
    1. Dias MS, Wang M, Rizk EB, Bowman R, Partington MD, Blount JP, Rocque BG, Hopson B, Ettinger D, Lee A, Walker WO (2021) Tethered spinal cord among individuals with myelomeningocele: an analysis of the National Spina Bifida Patient Registry. J Neurosurg: Pediatr 28(1):21–7. 10.3171/2020.12.PEDS20868 - PMC - PubMed
    1. Agarwalla PK, Dunn IF, Scott RM, Smith ER (2007) Tethered cord syndrome. Neurosurg Clin North Am 18(3):531–547. 10.1016/j.nec.2007.04.001 - PubMed
    1. Bhimani AD, Selner AN, Patel JB, Hobbs JG, Esfahani DR, Behbahani M, Zayyad Z, Nikas D, Mehta AI (2019) Pediatric tethered cord release: an epidemiological and postoperative complication analysis. J Spine Surg 5(3):337 - PMC - PubMed

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