Comparison of Perioperative Complication Rates in Congenital Scoliosis Patients With and Without Tethered Spinal Cord
Authors: Muñoz Andrea M. , Alvandi Leila M. , Gjonbalaj Edina , Morris Allyn , Sponseller Paul , Anderson Richard C.E. ,   Pediatric Spine Study Group, Gomez Jaime A. 
Published: December 2024

Background:
Congenital early onset scoliosis (C-EOS) often co-occurs with tethered spinal cord syndrome (TSCS), necessitating surgical intervention to address both conditions to prevent worsening neuromuscular function. Detethering can be done concurrently with spinal deformity correction (SDC), before SDC, or not done at all. This study explores perioperative complications in C-EOS patients with and without TSCS who underwent SDC with growing instrumentation or fusion. We hypothesize that C-EOS patients with a history of TSCS who underwent SDC with either growing instrumentation or fusion experienced higher rates of perioperative complications compared with those without TSCS. Among patients with a history of TSCS, we hypothesize that those who were detethered had fewer perioperative complications than those who were not detethered.

Methods:
Data from 751 C-EOS patients from an international spine registry were reviewed. After applying inclusion and exclusion criteria, 477 patients were divided into groups: those with TSCS (n=90) and those without (n=387). Among TSCS patients, the majority underwent detethering (n=54), whereas 36 did not. Demographics, magnetic resonance imaging (MRI) findings, treatment history, and surgical complications were assessed. Statistical analyses were conducted to compare demographic and clinical parameters, including complication rates, using appropriate tests. Postoperative complications were further categorized according to the modified Clavien-Dindo-Sink (mCDS) classification system.

Results:
Comparing C-EOS patients with and without TSCS revealed no significant differences in age at first MRI (P=0.52), pre-index major coronal curve (P=0.43), pre-index maximum sagittal kyphosis (P=0.113), the number of growth-friendly procedures (P=1.00), resection (P=0.071), osteotomy (P=0.081), intraoperative complications (P=0.088), postoperative complications (P=0.41), hardware failure (P=0.78), infections (P=0.26), and neurological complications (P=0.42). Postoperative complications further categorized using the mCDS demonstrated no significant differences between the groups (P=0.144). No significant differences were found in age at first MRI (P=0.60), pre-index major coronal curve (P=0.90), pre-index maximum sagittal kyphosis (P=0.50), resection (P=0.20), or osteotomy (P=0.47) between the detethered and not detethered cohorts. However, a higher percentage of TSCS patients without detethering underwent a growth-friendly procedure (P=0.003). In addition, TSCS patients without detethering experienced higher rates of postoperative complications (P=0.009), hardware failure (P=0.005), and infections (P=0.031) compared with those who underwent detethering. No differences were noted for intraoperative (P=0.059) or neurological (P=0.190) complications based on detethering status. Similarly, postoperative complications using the mCDS revealed that patients who were not detethered had higher rates of complications (P=0.017).

Conclusions:
Although there were no significant differences between C-EOS patients with and without TSCS, this study underscores the importance of detethering in C-EOS patients with concurrent TSCS. Detethering significantly reduced the risk of postoperative complications, hardware failure, and infection after SDC with growing instrumentation or fusion. However, given that the not detethered group had a higher frequency of growth-friendly procedures, these findings should be interpreted with caution. These findings highlight the potential benefits of detethering in improving surgical outcomes for C-EOS patients undergoing SDC with growing instrumentation or fusion.

Level of Evidence:
III