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

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.