261 Perioperative Complications and Secondary Retethering After Pediatric Tethered Cord Release Surgery

Abstract

INTRODUCTION: Tethered cord syndrome refers to a constellation of symptoms characterized by neurological, musculoskeletal, and urinary symptoms, caused by traction on the spinal cord. Various surgical techniques have been developed to address tethered cord syndrome depending on a diverse set of etiologies. Understanding perioperative complications and secondary retethering is crucial for optimizing patient outcomes and refining surgical techniques. METHODS: Retrospective review of children who underwent TCR surgery from July 2014 to April 2023. Data included demographics, perioperative characteristics, surgical techniques, and follow-up duration. Primary outcomes were 60-day postoperative complications and secondary retethering requiring repeat surgery. RESULTS: We identified 363 TCR surgeries (145 simple, 218 complex, 340 subjects). Mean follow-up was 446 days for simple TCRs and 731 days for complex TCRs. The adjusted 60-day complication rate was 3.8% (95%-CI 1.6-9.1) for simple TCRs and 11.9% (95%-CI 9.0-19.4) for complex TCRs. Lower weight, shorter surgical times, and ICU admission were associated with complications for simple TCRs. Soft tissue drains increased complications for complex TCRs. Secondary retethering rates were 1.4% for simple TCRs and 11.9% for complex TCRs. The 1-, 3-, and 5-year progression-free survival in complex cases were 94.7% (95%-CI 89.1-97.4), 77.7% (95%-CI 67.3-85.3), and 62.6% (95%-CI 46.5-75.1). Multivariate analysis revealed that prior detethering (OR 8.15, 95%-CI 2.33-28.50, p = 0.001) and usage of the operative laser (OR 10.43, 95%-CI 1.36-80.26, p = 0.024) were independently associated with secondary retethering in complex cases. CONCLUSIONS: This is the largest series examining postoperative complications and long-term secondary retethering in TCR surgery. Simple TCR surgeries demonstrated safety, rare complications, and low secondary retethering rates. Complex TCR surgeries presented higher risks for complications and secondary retethering. Modifiable risk factors, such as operative laser usage, influenced secondary retethering in complex cases.