Logistic regression analysis of the efficacy in children with tethered cord syndrome

Abstract

Objective To explore the factors associated with efficacy in children with tethered cord syndrome (TCS). Methods The clinical data of 293 TCS children were retrospectively reviewed and the factors affecting the efficacy evaluated by Logistic regression analysis. There were 140 boys and 153 girls with a median age of 9 months (2 days to 14 years). The age distribution was <6 months (n=102), 6 months~<3 years (n=99) and ≥3 years (n=92). And the clinical type was lipoma (n=124) and non-lipoma (n=169). According to the Hoffman’s neurofunctional classification, the severity of neurological injury was mild, moderate and severe. The surgical approaches included combination release, routine release and simple repair. Efficacy was assigned as a dependent variable of progression, stabilizing, regression and complete resolution. Factors related to the efficacy were analyzed with Logistic regression model, which focused on surgical approach, pathological classification, age and severity of neurological injury. Results ① Surgical method: odds ratio (OR) value of combination release was 66.92 and routine release 13.98 (P<0.001); ② Pathological classification: OR value of non-lipoma type was 2.17 (P=0.005); ③ Age: OR value of age <6 months was 3.43 (P=0.000) and age from 6 months to 3 years 2.27 (P=0.009); ④ Severity of neurological injury: OR value of mild form was 35.24 and median form 12.86 (P<0.001). The factors related to efficacy were surgical approach, severity of neurological injury, age and pathological type in a decreasing order of priority. Combination release had a priority over routine release while simple repair had obviously reduced efficacy. Mild neurological injury, younger age or non-lipoma type had better outcomes. Conclusions The factors related to efficacy of TCS vary greatly. Early observation, early diagnosis and early surgery are recommended. On the basic of intradural loosening, epidural exploration and adhesiolysis for TCS is considerably more efficacious in improving neurological functions than routine procedures. Key words: Spinal cord; Syndrom; Regression analysis