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Use of lumbar laminoplasty vs. laminotomy for transection of the filum terminale does not affect early complication rates or postoperative course

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Abstract

Introduction

Various techniques are used for spinal cord untethering. The purpose of this study was to compare patient characteristics, postoperative course, and early complications after laminotomy vs. laminoplasty for transection of the filum terminale for tethered cord release.

Methods

Retrospective analysis of clinical and magnetic resonance imaging data was undertaken for all patients (<18 years) who underwent tethered cord release by transection of the filum terminale at Oregon Health & Science University, Doernbecher Children’s Hospital, from 2000 to 2011.

Results

Data from two hundred and forty-eight patients were analyzed. Mean age was 5.2 years (range 0.3 to 16.8 years). Access to the thecal space during surgery was achieved using laminotomy or laminoplasty in 82 (33.1 %) and 166 (66.9 %) patients, respectively. Laminoplasty patients were significantly younger than laminotomy patients (3.2 vs. 9.3 years, p < 0.0001); other clinical and radiographic characteristics were similar between the groups. Nine patients (3.6 %) experienced early complications, including cerebrospinal fluid leak (n = 2), suprafascial infection requiring surgical management and intravenous (IV) antibiotics (n = 3) or IV antibiotics alone (n = 1), a small area of peri-incisional cutaneous necrosis (n = 1), perioperative seizures (n = 1), and mild, transient malignant hyperthermia (n = 1). There was no difference in the number of early complications between the two groups. Univariate and multivariate analyses revealed no significant risk factor for postoperative complication associated with technique. As judged by caregivers, independent of surgical technique, 97 % of patients improved after surgery.

Conclusion

There was no difference in complication risk when performing transection of the filum terminale for tethered cord release using laminotomy or laminoplasty.

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Acknowledgments

The authors would like to thank Shirley McCartney, Ph.D., for the editing assistance and Andy Rekito, M.S., for the medical illustration and figure preparation. This research was supported by the Oregon Health & Science University Campagna Scholarship to MJS. MJS is currently supported by the Ruth L. Kirschstein National Research Service Award (F30 CA177267-02) from the National Cancer Institute.

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. A distinct but largely overlapping population of pediatric and adult patients was analyzed and reported separately in a manuscript focusing on the histopathology of filum terminale specimens in tethered cord release [11].

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Authors and Affiliations

  1. Department of Neurological Surgery, Oregon Health & Science University, 3303 SW Bond Ave, Portland, OR, 97239, USA

    M. J. Strong, E. M. Thompson, N. Roundy & N. R. Selden

  2. Division of Neurological Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada

    E. M. Thompson

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  1. M. J. Strong
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  2. E. M. Thompson
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  3. N. Roundy
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  4. N. R. Selden
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Correspondence to N. R. Selden.

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Strong, M.J., Thompson, E.M., Roundy, N. et al. Use of lumbar laminoplasty vs. laminotomy for transection of the filum terminale does not affect early complication rates or postoperative course. Childs Nerv Syst 31, 597–601 (2015). https://doi.org/10.1007/s00381-015-2615-8

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  • DOI: https://doi.org/10.1007/s00381-015-2615-8

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