Comparison of outcomes after spinal column shortening for secondary tethered cord syndrome in pediatric versus adult patients: the University of Oklahoma experience.

Objective: Spinal column shortening (SCS) is an emerging alternative to traditional untethering in cases of secondary tethered cord syndrome. It was originally described and applied in adult patients with spinal dysraphism. In the more recent past, SCS has been used in pediatric patients. A comparison between pediatric and adult patients undergoing SCS has not been performed previously.

Methods: A retrospective analysis was conducted on 19 patients (11 children, 8 adults) who underwent SCS procedures from November 30, 2020, to July 21, 2024, at the University of Oklahoma. Outcomes were assessed based on changes in pain, overall symptom burden, subjective bowel/bladder symptoms, and objective testing of urodynamic function. The median follow-up period was 30 months (range 10-41 months).

Results: Most vertebral column resections were performed at the T12 level (79%), with T10-L2 being the most common fusion level (68%). There were no significant preoperative differences in clinical features between children and adults. Both children and adults experienced significant reductions in pain (p = 0.002 and p = 0.018, respectively) and overall symptom burden (p < 0.001 and p = 0.003, respectively). Complete symptom resolution was achieved in 63% of children and 25% of adults. Improvements in objective urodynamic function were observed but were not statistically significant in either group (p = 0.082 for children, p = 0.351 for adults). However, only children reported significant improvement in bowel/bladder function (p < 0.01). The difference in surgical metrics or postoperative clinical features was not significant between children and adults.

Conclusions: SCS procedures appear to be effective in reducing pain and overall symptom burden in both pediatric and adult patients with complex tethered cord syndrome. SCS seems to improve bowel/bladder symptoms in children specifically. Further research with larger cohorts and longer follow-up periods is warranted to confirm these findings and assess long-term outcomes.