Is detethering necessary before deformity correction in congenital scoliosis associated with tethered cord syndrome: a m
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REVIEW ARTICLE
Is detethering necessary before deformity correction in congenital scoliosis associated with tethered cord syndrome: a meta‑analysis of current evidence Kaustubh Ahuja1 · Syed Ifthekar1 · Samarth Mittal1 · Gagandeep Yadav1 · P. Venkata Sudhakar1 · Sitanshu Barik1 · Pankaj Kandwal1 Received: 29 September 2020 / Revised: 29 September 2020 / Accepted: 7 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To compare the clinical and radiological outcomes in patients with congenital scoliosis (CS) and tethered cord syndrome (TCS) undergoing deformity correction with (NI group) versus without (NNI group) prior neurosurgical intervention aimed at detethering the cord. Methods A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until March 2020. Inclusion criteria was studied describing performance of deformity correction and fusion surgery for congenital scoliosis with tethered cord syndrome with or without prior detethering procedure. Studies describing growth sparing procedures or congenital scoliosis associated with non-tethering pathologies such as syrinx were excluded. Case reports and series with less than 10 subjects were also excluded. NIH quality assessment tool was used for assessing quality of individual study. Results Sixteen studies were included for analysis of which eight were found to be retrospective case series (level IV evidence) and retrospective case–control studies (level III evidence) each. Overall proportional meta-analysis found no significant difference in correction rate, operative duration, blood loss or complication rate between the NI and NNI groups. However, subgroup analysis performed after inclusion of only level III evidence studies revealed significantly lesser operative duration and blood loss with comparable correction and complication rate in NNI group. Conclusion Deformity correction and fusion surgery may be performed safely and effectively in CS with TCS patients without the need of a prior detethering procedure. Keywords Congenital scoliosis · Intraspinal anomalies · Detethering · Neurological complications · Surgical outcomes
Introduction Congenital scoliosis (CS) is a complex spinal deformity, often associated with a number of intraspinal anomalies. The incidence of intraspinal anomalies in association with CS has been reported to range from 25 to 37% across the literature [1–5]. Tethered cord syndrome (TCS) is the commonest reported anomaly present in about 12 to 17% of the patients suffering from CS [1, 3]. While in its simplest form TCS is associated with a thickened (
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