Improved Outcomes of Tethered Cord Repair Using a Plastic Surgical Composite Tissue Closure at a High Volume University Hospital

Introduction: Previous studies demonstrate the benefit of symptomatic tethered cord release, however, complications such as seroma, CSF leak and infection continue to plague these patients. We propose that composite tissue closure of tethered cord repairs yields superior outcomes and that a collaborative effort between Neurosurgery and Plastic Surgery may result in enhanced structural and functional results.

Methods: This is a 15 year (1994-2008) retrospective study of consecutive patients with tethered cord syndrome treated by 2 neurosurgeons and 2 plastic surgeons at a single institution. All consecutive patients who underwent tethered cord release by neurosurgery and subsequent composite tissue closure with fascial and musculofascial flaps were included. Data was collected by retrospective chart review and analyzed using parametric methods.

Results: Eighty six consecutive patients were captured with an average follow up time of 29 months. There were no statistical differences in follow up time, co-morbidities or surgeon when comparing hospital readmission or re-operation. Closures consisted of muscle flaps and skin (77%; 66/86) or fascial flaps and skin (23%; 20/86). There was no statistical difference in complications when comparing the muscle vs. fascial closures (p=0.59). One patient had a post operative infection (1.2%), and one patient had a post-operative leak (1.2%). These findings demonstrate a substantial improvement in outcomes when compared with previously described neurosurgical repairs which report complication rates at 9.5%, infection rates as high as 9% and CSF leak rates at 4%-17%.

Conclusion: We believe composite tissue closure improves wound repair after tethered cord release by providing a durable additional layer of vascularized tissue between the skin and the spinal cord. These outcomes were vastly improved over outcomes at institutions where neurosurgeons perform primary closure alone. Our results support the idea that neurosurgeons should consider consultation of plastic surgeons for composite tissue repair when treating patients with tethered cord syndrome surgically.