Adults are not just big kids: adults have higher reoperation and complication rates following lumbar laminectomy for tethered cord release

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-10-03 DOI:10.1016/j.jocn.2025.111664

Adeesya Gausper , Andrew Miller , Weston Wright , Justin K. Scheer , David Bonda , Tiffany G. Perry , Moise Danielpour , David L. Skaggs , Corey T. Walker , Alexander Tuchman

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引用次数: 0

Abstract

Objective

Tethered cord syndrome (TCS) is a neurological condition characterized by pathological tension on the spinal cord and is treated with surgical detethering. While traditionally considered a pediatric condition, TCS in adults likely differs in pathophysiology, clinical presentation, and surgical outcomes. This study aims to compare reoperation rates and early postoperative complications following tethered cord release (TCR) in pediatric and adult patients.

Methods

A retrospective study of the PearlDiver national insurance claims database was conducted. Patients who underwent lumbar laminectomy with release of tethered cord were identified and grouped into pediatric (<18 years) and adult (≥18 years) cohorts. The primary outcome was rate of subsequent lumbar surgery within 2-years of index surgery, including repeat TCR, CSF leak repair, syrinx drainage, 3-column osteotomy, lumbar laminectomy, and lumbar fusion. Secondary outcomes included 90-day complication rates. Statistical significance was determined with chi-square analysis.

Results

5,780 pediatric and 1,670 adult patients were identified who underwent TCR. Average age at index surgery was 6.1 (± 4.9) years in the pediatric cohort and 41.6 (± 16.4) years in adults. The overall rate of subsequent lumbar surgery at 2-years following index surgery was significantly higher in adult patients (12.75 % vs 3.89 %, p < 0.00001). The most common reoperation in both cohorts was CSF leak repair (7.66 % adult and 1.87 % pediatric patients at 2-years). Adult patients had a significantly higher 90-day complication rate (21.6 % vs 15.8 %, p < 0.00001), and most complications in both cohorts were attributable to urinary tract infections.

Conclusions

Adult patients have nearly threefold increased risk of reoperation, over fourfold risk of CSF leak repair, and a higher rate of postoperative complications following TCR. These findings highlight the need for tailored surgical planning, patient counseling, and long-term follow-up in pediatric and adult patients undergoing TCR. It is important for surgeons to recognize the significantly higher rates of complications and reoperations in adults and to avoid applying pediatric outcomes to the adult population.

查看原文本刊更多论文

成年人不只是大孩子：成年人在腰椎椎板切除术后有更高的再手术率和并发症发生率

目的脊髓栓系综合征（TCS）是一种以脊髓病理性张力为特征的神经系统疾病，治疗方法为手术解栓。虽然传统上被认为是一种儿科疾病，但成人的TCS可能在病理生理、临床表现和手术结果上有所不同。本研究旨在比较小儿和成人脊髓栓系松解术（TCR）的再手术率和术后早期并发症。方法对PearlDiver国家保险理赔数据库进行回顾性研究。接受腰椎椎板切除术并松解系带的患者被确定并分为儿科（18岁）和成人（≥18岁）队列。主要观察指标为术后2年内腰椎手术的发生率，包括重复TCR、脑脊液漏修补、鼻灌管引流、3柱截骨、腰椎椎板切除术和腰椎融合。次要结局包括90天并发症发生率。采用卡方分析确定统计学显著性。结果5,780名儿童和1,670名成人患者接受了TCR。儿童患者的平均手术年龄为6.1（±4.9）岁，成人患者的平均手术年龄为41.6（±16.4）岁。成人患者在指数手术后2年内腰椎手术的总体发生率明显更高（12.75% vs 3.89%, p < 0.00001）。两组患者中最常见的再手术是脑脊液漏修补术（2岁时成人患者占7.66%，儿科患者占1.87%）。成人患者的90天并发症发生率显著高于成人患者（21.6% vs 15.8%, p < 0.00001），两组患者的大多数并发症均可归因于尿路感染。结论成年患者再手术风险增加近3倍，脑脊液漏修补风险增加4倍以上，术后并发症发生率增加。这些发现强调了对接受TCR的儿童和成人患者进行量身定制的手术计划、患者咨询和长期随访的必要性。对于外科医生来说，重要的是要认识到成人并发症和再手术的发生率明显较高，并避免将儿科的结果应用于成人人群。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.