• Matthew C Findlay, Samuel A Tenhoeve, Chase M Johansen, Michael P Kelly, Peter O Newton, Rajiv R Iyer, KestleJohn R WJRWDepartment of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah., David D Gonda, Douglas L Brockmeyer, and Vijay M Ravindra.
• Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah.
• Spine. 2024 Nov 1; 49 (21): 152115291521-1529.

Study DesignSystematic review.ObjectiveTo identify commonly reported indications and outcomes in spinal column shortening (SCS) procedures.BackgroundSCS is a surgical procedure used in patients with tethered cord syndrome-characterized by abnormal attachment of neural components to surrounding tissues-to shorten the vertebral column, release tension on the spinal cord/neural elements, and alleviate associated symptoms.Patients And MethodsPubMed and EMBASE searches captured SCS literature published between 1950 and 2023. Prospective/retrospective cohort studies and case series were included without age limit or required follow-up period. Review articles without new patient presentations, meta-analyses, systematic reviews, conference abstracts, and letters were excluded. Studies included adult and pediatric patients.ResultsThe 29 identified studies represented 278 patients (aged 5-76 yr). In 24.1% of studies, patients underwent primary tethered cord syndrome intervention through SCS. In 41.4% of studies, patients underwent SCS after failed previous primary detethering (24.1% of studies were mixed and 10.3% were unspecified). The most commonly reported nongenitourinary/bowel surgical indications were back pain (55.2%), lower-extremity pain (48.3%), lower-extremity weakness (48.3%), lower-extremity numbness (34.5%), and lower-extremity motor dysfunction (34.5%). Genitourinary/bowel symptoms were most often described as nonspecific bladder dysfunction (58.6%), bladder incontinence (34.5%), and bowel dysfunction (31.0%). After SCS, nongenitourinary/bowel outcomes included lower-extremity pain (44.8%), back pain (31.0%), and lower-extremity sensory and motor function (both 31.0%). Bladder dysfunction (79.3%), bowel dysfunction (34.5%), and bladder incontinence (13.8%) were commonly reported genitourinary/bowel outcomes. In total, 40 presenting surgical indication categories and 33 unique outcome measures were reported across studies. Seventeen of the 278 patients (6.1%) experienced a complication.ConclusionThe SCS surgical literature displays variability in operative indications and postoperative outcomes. The lack of common reporting mechanisms impedes higher-level analysis. A standardized outcomes measurement tool, encompassing both patient-reported outcome measures and objective metrics, is necessary.Level Of EvidenceLevel IV.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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