Dulfer, S.E. (2016) Spinal Cord Surgery : Rationalization and proposition of stadardized outcome measures in neurosurgical treatment of the spinal cord with the use of intraoperative neurophysiological monitoring. thesis, Medicine.
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Abstract
Neurosurgery 1 ABSTRACT (ENGLISH) Introduction The use of intraoperative neurophysiological monitoring (IONM) in tethered cord surgery is common practice, and its feasibility and safety are established. Surgery in case of a tethered cord syndrome is performed to relief, but also to prevent secondary symptoms in the neurological, urological and orthopedic field. In order to evaluate the efficacy of the detethering and the longterm effects on tethered spinal cord symptoms, a substantial period of time for follow-up is required. Therefore this study extended the follow-up of an already existing cohort. Besides this, the published clinical study of this cohort provided new insights that have shown us that there is a need for relevant standardized outcome measures in spinal cord surgery. Therefore, the second aim for this study was to evaluate pre-, intra- and post-operative results in patients who underwent surgical detethering for a tethered spinal cord retrospectively, to learn which outcome measures are relevant for later prospective studies in patients who will receive spinal cord surgery. Methods A total of 60 patients who underwent surgical detethering with IONM during a 9 year period were included. A distinction was made between a low-risk group, a high-risk group and a group of patients that underwent a secondary detetethering (redo). All patients were scored on neurological, urological, orthopedic (scoliosis) and pain symptoms at four moments in time; preand postoperative, and during follow-up after a mean of 4.6 and a mean of 11.2 years. Changes in tethered spinal cord symptoms over time were evaluated. The mobility and quality of life were also assessed using validated questionnaires. To formulate standardized outcome measures for evaluating spinal cord surgery, experiences of this retrospective study, a literature research on validated questionnaires and expert opinions from the field were taken into account. Results The long-term outcome comparing postoperative with last follow-up scoring, showed improvement on neurological, urological, scoliosis and pain symptoms in 6(10.0%), 7(11,7%) 1(1,7%) and 8(13,3%) patients respectively. Neurological, urological and pain deterioration was found in 7(11,7), 4(6,7%) and 4(6,7%) patients respectively. Progressive scoliosis occurred in 11 patients (18,6%; mean age 16,7 years). Mobility score was only significantly different when comparing the high-risk group and the redo’s (p=0,003). The quality of life was lower when comparing it with a healthy Dutch population. From experiences of this retrospective study, the literature research and the expert opinions a prospective design was made. Conclusion A long-term lasting effect of relieve of symptoms was found, except for scoliosis, that appeared to be progressive in 11 patients. This finding might suggest that tethered cord surgery may not prevent progression of scoliosis. A more accurate FU might help to minimalize the extent of scoliosis progression in these patients. Our developed standardized outcome measures can be perfectly used in a prospective study design.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Groen, Prof. dr. R.J.M. and Drost, Dr. G. and Hoving, Dr. E. W. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:02 |
| Last Modified: | 25 Jun 2020 11:02 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2230 |
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