• Jing-Hui Huang, Wei-Zhou Yang, Chao Shen, Michael S Chang, Huan Li, Zhuo-Jing Luo, and Hui-Ren Tao.
• *Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China†Adult and Pediatric Spine Surgery, Sonoran Spine Center, Mesa, AZ; and‡Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
• Spine. 2015 Oct 15; 40 (20): E1103-9.

Study DesignRetrospective case series.ObjectiveTo investigate the safety and efficacy of spine-shortening osteotomy for congenital scoliosis with tethered cord.Summary Of Background DataConventional surgery for congenital scoliosis associated with tethered cord risks the complications of detethering. Spine-shortening osteotomy holds the potential to correct scoliosis and decrease spinal cord tension simultaneously without an extra detethering procedure, but no data on this issue is available.Methods21 patients (14 females and 7 males, average age 15.4 yr) underwent spine-shortening osteotomy without detethering. All of the patients had tethered cord. Patients with main curve more than 90° underwent vertebral column resection (VCR), whereas the others had pedicle subtraction osteotomy (PSO) performed. The average postoperative follow-up period was 45.2 months.ResultsThe mean operation time was 544.5 min with average blood loss of 2769.1 ml. The deformity correction was 61.3% in the coronal plane and 43.9° in the sagittal plane. 10 patients had neurological deficits preoperatively. At the final follow-up, the deficits in 8 (80%) patients were significantly improved, whereas 2 (20%) remained unchanged. At final follow-up, 71.4% (5/7) patients reported improvement in motor function, 100% (3/3) had improved pain scores, and 75% (3/4) reported better sensory function after the spine-shortening osteotomy. Urinary dysfunction and bowel incontinence present preoperatively in 3 patients all recovered by final follow-up. 5 (23.8%) patients incurred complications including temporary neurological deterioration in 1 patient, urinary tract infection in 2 patients, cerebrospinal fluid leakage in 1 patient, and blood loss more than 5000 ml in 1 patient.ConclusionSpine-shortening osteotomy is a safe and effective procedure for congenital scoliosis associated with tethered cord. Spine-shortening osteotomy at the thoracic apical vertebrae level not only corrects the spine deformity but also simultaneously releases the tension of the tethered cord, resulting in improved neurologic function.

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