{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T09:18:41Z","timestamp":1770887921858,"version":"3.50.1"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>In posterior vertebral column subtraction osteotomy (PVCSO), a section of a thoracic or lumbar vertebra and the adjacent disc are resected to shorten the spinal column, aiming to permanently alleviate tension on the spinal cord in patients with recurrent tethered cord syndrome (TCS). The effects of this procedure on the spinal cord are not well characterized. This study investigated morphometric changes in the cord following PVCSO and assessed associated clinical outcomes in patients with recurrent TCS.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective review of patients with recurrent TCS undergoing PVCSO with robotic assistance at the authors\u2019 tertiary care institution between 2019 and 2023 was performed. Clinical data were recorded from electronic medical records, and morphometric measurements, including T12\u2013L2 sagittal height, intradural diameter, and the diameters, area, eccentricity, and positioning of the spinal cord, were collected from MRI. Spinal cord dimensions including anteroposterior and lateral diameters, area, eccentricity, positioning, and intradural diameter were compared before and after surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Six patients were included in this study. At 6-week follow-up, all patients had improvement on lower-extremity motor function examinations, 40% had improvement on lower-extremity sensory function examinations, and 83% had improved self-reported pain. Bladder and bowel incontinence were improved in 50% and 60%, respectively. PVCSO reduced the height of the spinal column by a mean of 18.1 \u00b1 5.2 mm. PVCSO increased the mean spinal cord anteroposterior diameter by 0.8 \u00b1 0.5 mm at T12 (p = 0.03) and the mean area by 0.4 \u00b1 0.3 mm<jats:sup>2<\/jats:sup> at T12 (p = 0.03). The mean eccentricity of the spinal cord decreased by 0.15 \u00b1 0.15 at L1 (p = 0.05), indicating that the spinal cord became more circular after surgery. No major complications were reported, although 1 patient experienced atelectasis and pulmonary embolism postoperatively.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This study provides novel insights into the morphometric changes induced by PVCSO and their correlation with clinical outcomes in patients with TCS. The procedure effectively increased spinal cord dimensions, alleviating tension and offering potential benefits in symptom relief. The study underscores the need for objective metrics to guide surgical decision-making and enhance the long-term success of PVCSO in the management of TCS.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.6.spine24176","type":"journal-article","created":{"date-parts":[[2024,10,12]],"date-time":"2024-10-12T01:58:01Z","timestamp":1728698281000},"page":"1-9","source":"Crossref","is-referenced-by-count":2,"title":["Morphometric analysis of the spinal cord in patients undergoing posterior vertebral column subtraction osteotomy for recurrent tethered cord syndrome"],"prefix":"10.3171","author":[{"given":"Kelly","family":"Jiang","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carly","family":"Weber-Levine","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikas N.","family":"Vattipally","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. Daniel","family":"Davidar","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max","family":"Kerensky","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew M.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denis","family":"Routkevitch","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan","family":"Judy","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Ashayeri","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Lubelski","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mari","family":"Groves","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalil","family":"Husari","sequence":"additional","affiliation":[{"name":"Neurology, Johns Hopkins Hospital, Baltimore; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Theodore","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Tethered cord syndrome: a review of the literature from embryology to adult presentation","volume":"29","author":"Hertzler DA II","year":"2010","unstructured":"Hertzler DA II, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus. 2010;29(1):E1."},{"issue":"3","key":"b2","series-title":"Pediatr Neurosurg","first-page":"236","article-title":"Tethered cord syndrome: an updated review","volume":"43","author":"Lew SM","year":"2007","unstructured":"Lew SM, Kothbauer KF. Tethered cord syndrome: an updated review. Pediatr Neurosurg. 2007;43(3):236\u2013248."},{"issue":"1","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"3","article-title":"Spinal column shortening for secondary tethered cord syndrome: radiographic, clinical, patient-reported, and urodynamic short-term outcomes","volume":"28","author":"McVeigh LG","year":"2021","unstructured":"McVeigh LG, Anokwute MC, Belal A. Spinal column shortening for secondary tethered cord syndrome: radiographic, clinical, patient-reported, and urodynamic short-term outcomes. J Neurosurg Pediatr. 2021;28(1):3\u201312."},{"key":"b4","series-title":"StatPearls Publishing;","article-title":"Tethered cord syndrome (TCS). In: StatPearls","author":"Weisbrod LJ","year":"2024","unstructured":"Weisbrod LJ, Thorell W. Tethered cord syndrome (TCS). In: StatPearls. StatPearls Publishing; 2024. Accessed July 17, 2024.http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK585121\/"},{"issue":"1","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"4","article-title":"Magnetic resonance imaging in the prone position and the diagnosis of tethered spinal cord","volume":"21","author":"Stamates MM","year":"2018","unstructured":"Stamates MM, Frim DM, Yang CW, Katzman GL, Ali S. Magnetic resonance imaging in the prone position and the diagnosis of tethered spinal cord. J Neurosurg Pediatr. 2018;21(1):4\u201310."},{"issue":"1","key":"b6","series-title":"J Neurosurg Spine","first-page":"76","article-title":"Use of prone position magnetic resonance imaging for detecting the terminal filum in patients with occult tethered cord syndrome","volume":"18","author":"Nakanishi K","year":"2013","unstructured":"Nakanishi K, Tanaka N, Kamei N,  Use of prone position magnetic resonance imaging for detecting the terminal filum in patients with occult tethered cord syndrome. J Neurosurg Spine. 2013;18(1):76\u201384."},{"issue":"1","key":"b7","series-title":"Radiology","first-page":"208","article-title":"Medullary cone movement in subjects with a normal spinal cord and in patients with a tethered spinal cord","volume":"220","author":"Witkamp TD","year":"2001","unstructured":"Witkamp TD, Vandertop WP, Beek FJA, Notermans NC, Gooskens RHJM, van Waes PFGM. Medullary cone movement in subjects with a normal spinal cord and in patients with a tethered spinal cord. Radiology. 2001;220(1):208\u2013212."},{"issue":"7","key":"b8","series-title":"Neurol Res","first-page":"719","article-title":"Tethered cord syndrome: overview of diagnosis and treatment","volume":"26","author":"Yamada S","year":"2004","unstructured":"Yamada S, Won DJ, Siddiqi J, Yamada SM. Tethered cord syndrome: overview of diagnosis and treatment. Neurol Res. 2004;26(7):719\u2013721."},{"issue":"4","key":"b9","series-title":"J Neurosurg Spine","first-page":"278","article-title":"Posterior vertebral column subtraction osteotomy: a novel surgical approach for the treatment of multiple recurrences of tethered cord syndrome","volume":"10","author":"Hsieh PC","year":"2009","unstructured":"Hsieh PC, Ondra SL, Grande AW. Posterior vertebral column subtraction osteotomy: a novel surgical approach for the treatment of multiple recurrences of tethered cord syndrome. J Neurosurg Spine. 2009;10(4):278\u2013286."},{"issue":"6","key":"b10","series-title":"J Neurosurg Pediatr","first-page":"624","article-title":"Spinal column shortening for tethered cord syndrome: a systematic review and individual patient data meta-analysis","volume":"29","author":"McVeigh LG","year":"2022","unstructured":"McVeigh LG, Anokwute MC, Chen S, Jea A. Spinal column shortening for tethered cord syndrome: a systematic review and individual patient data meta-analysis. J Neurosurg Pediatr. 2022;29(6):624\u2013633."},{"issue":"1","key":"b11","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Posterior vertebral column subtraction osteotomy for the treatment of tethered cord syndrome: review of the literature and clinical outcomes of all cases reported to date","volume":"29","author":"Hsieh PC","year":"2010","unstructured":"Hsieh PC, Stapleton CJ, Moldavskiy P,  Posterior vertebral column subtraction osteotomy for the treatment of tethered cord syndrome: review of the literature and clinical outcomes of all cases reported to date. Neurosurg Focus. 2010;29(1):E6."},{"issue":"6","key":"b12","series-title":"J Neurosurg Spine","first-page":"478","article-title":"Vertebral column subtraction osteotomy for recurrent tethered cord syndrome in adults: a cadaveric study","volume":"4","author":"Grande AW","year":"2006","unstructured":"Grande AW, Maher PC, Morgan CJ. Vertebral column subtraction osteotomy for recurrent tethered cord syndrome in adults: a cadaveric study. J Neurosurg Spine. 2006;4(6):478\u2013484."},{"issue":"5","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"607","article-title":"Perioperative complications and secondary retethering after pediatric tethered cord release surgery","volume":"32","author":"Pan J","year":"2023","unstructured":"Pan J, Boop SH, Barber JK. Perioperative complications and secondary retethering after pediatric tethered cord release surgery. J Neurosurg Pediatr. 2023;32(5):607\u2013616."},{"issue":"3","key":"b14","series-title":"Neurosurgery","first-page":"637","article-title":"Posterior vertebral column subtraction osteotomy for recurrent tethered cord syndrome: a multicenter, retrospective analysis","volume":"88","author":"Theodore N","year":"2021","unstructured":"Theodore N, Cottrill E, Kalb S. Posterior vertebral column subtraction osteotomy for recurrent tethered cord syndrome: a multicenter, retrospective analysis. Neurosurgery. 2021;88(3):637\u2013647."},{"issue":"1","key":"b15","series-title":"Commun Med (Lond)","first-page":"4","article-title":"Tethered spinal cord tension assessed via ultrasound elastography in computational and intraoperative human studies","volume":"4","author":"Kerensky MJ","year":"2024","unstructured":"Kerensky MJ, Paul A, Routkevitch D. Tethered spinal cord tension assessed via ultrasound elastography in computational and intraoperative human studies. Commun Med (Lond). 2024;4(1):4."},{"issue":"5","key":"b16","series-title":"Neurol Res","first-page":"340","article-title":"Spine-shortening osteotomy for patients with tethered cord syndrome: a systematic review and meta-analysis","volume":"40","author":"Lin W","year":"2018","unstructured":"Lin W, Xu H, Duan G. Spine-shortening osteotomy for patients with tethered cord syndrome: a systematic review and meta-analysis. Neurol Res. 2018;40(5):340\u2013363."},{"issue":"1","key":"b17","series-title":"J Neurosurg Spine","first-page":"21","article-title":"Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele","volume":"15","author":"Kokubun S","year":"2011","unstructured":"Kokubun S, Ozawa H, Aizawa T, Ly NM, Tanaka Y. Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. J Neurosurg Spine. 2011;15(1):21\u201327."},{"issue":"6","key":"b18","series-title":"J Neurosurg Spine","first-page":"958","article-title":"Spinal column shortening versus revision detethering for recurrent adult tethered cord syndrome: a preliminary comparison of perioperative and clinical outcomes","volume":"32","author":"Zhang C","year":"2020","unstructured":"Zhang C, Chang CC, Mummaneni PV,  Spinal column shortening versus revision detethering for recurrent adult tethered cord syndrome: a preliminary comparison of perioperative and clinical outcomes. J Neurosurg Spine. 2020;32(6):958\u2013964."},{"issue":"4","key":"b19","series-title":"Childs Nerv Syst","first-page":"1111","article-title":"Disparities in indications and outcomes reporting for pediatric tethered cord surgery: the need for a standardized outcome assessment tool","volume":"40","author":"Findlay MC","year":"2024","unstructured":"Findlay MC, Tenhoeve S, Terry SA,  Disparities in indications and outcomes reporting for pediatric tethered cord surgery: the need for a standardized outcome assessment tool. Childs Nerv Syst. 2024;40(4):1111\u20131120."},{"issue":"6","key":"b20","series-title":"J Neurosurg Pediatr","first-page":"703","article-title":"Spinal column shortening for tethered cord syndrome associated with myelomeningocele, lumbosacral lipoma, and lipomyelomeningocele in children and young adults","volume":"19","author":"Aldave G","year":"2017","unstructured":"Aldave G, Hansen D, Hwang SW, Moreno A, Brice\u00f1o V, Jea A. Spinal column shortening for tethered cord syndrome associated with myelomeningocele, lumbosacral lipoma, and lipomyelomeningocele in children and young adults. J Neurosurg Pediatr. 2017;19(6):703\u2013710."},{"issue":"6","key":"b21","series-title":"Spine J","first-page":"998","article-title":"Clinical evaluation of an innovative operative procedure in the treatment of the tethered cord syndrome","volume":"18","author":"Hou Y","year":"2018","unstructured":"Hou Y, Sun J, Shi J. Clinical evaluation of an innovative operative procedure in the treatment of the tethered cord syndrome. Spine J. 2018;18(6):998\u20131004."},{"issue":"6","key":"b22","series-title":"Global Spine J","first-page":"535","article-title":"Comparative study of untethering and spine-shortening surgery for tethered cord syndrome in adults","volume":"6","author":"Nakashima H","year":"2016","unstructured":"Nakashima H, Imagama S, Matsui H. Comparative study of untethering and spine-shortening surgery for tethered cord syndrome in adults. Global Spine J. 2016;6(6):535\u2013541."},{"issue":"14","key":"b23","series-title":"Spine (Phila Pa 1976).","first-page":"1198","article-title":"Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures","volume":"37","author":"Auerbach JD","year":"2012","unstructured":"Auerbach JD, Lenke LG, Bridwell KH. Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976).2012;37(14):1198\u20131210."},{"issue":"1","key":"b24","series-title":"J Neurosurg Spine","first-page":"120","article-title":"The effect of spinal osteotomies on spinal cord tension and dural buckling: a cadaveric study","volume":"23","author":"Safain MG","year":"2015","unstructured":"Safain MG, Burke SM, Riesenburger RI, Zerris V, Hwang SW. The effect of spinal osteotomies on spinal cord tension and dural buckling: a cadaveric study. J Neurosurg Spine. 2015;23(1):120\u2013127."},{"issue":"9","key":"b25","series-title":"Acta Neurochir (Wien)","first-page":"2087","article-title":"Secondary tethered cord syndrome in adult patients: retethering rates, long-term clinical outcome, and the effect of intraoperative neuromonitoring","volume":"162","author":"Finger T","year":"2020","unstructured":"Finger T, Aigner A, Depperich L,  Secondary tethered cord syndrome in adult patients: retethering rates, long-term clinical outcome, and the effect of intraoperative neuromonitoring. Acta Neurochir (Wien). 2020;162(9):2087\u20132096."},{"issue":"9","key":"b26","series-title":"Childs Nerv Syst","first-page":"1445","article-title":"The value of intraoperative neurophysiological monitoring in tethered cord surgery","volume":"27","author":"Hoving EW","year":"2011","unstructured":"Hoving EW, Haitsma E, Oude Ophuis CMC, Journ\u00e9e HL. The value of intraoperative neurophysiological monitoring in tethered cord surgery. Childs Nerv Syst. 2011;27(9):1445\u20131452."},{"issue":"3","key":"b27","series-title":"J Orthop Sci","first-page":"363","article-title":"Spinal shortening osteotomy for adult tethered cord syndrome evaluated by intraoperative ultrasonography","volume":"26","author":"Ide K","year":"2021","unstructured":"Ide K, Hasegawa T, Yamato Y. Spinal shortening osteotomy for adult tethered cord syndrome evaluated by intraoperative ultrasonography. J Orthop Sci. 2021;26(3):363\u2013368."},{"key":"b28","series-title":"J Clin Neurosci","first-page":"18","article-title":"Applications of elastography in operative neurosurgery: a systematic review","volume":"104","author":"Hersh AM","year":"2022","unstructured":"Hersh AM, Weber-Levine C, Jiang K,  Applications of elastography in operative neurosurgery: a systematic review. J Clin Neurosci. 2022;104:18\u201328."},{"issue":"6","key":"b29","series-title":"J Neurosurg Spine","first-page":"807","article-title":"Effects of compressive lesions on intraoperative human spinal cord elasticity","volume":"35","author":"Al-Habib A","year":"2021","unstructured":"Al-Habib A, Alhothali W, Albakr A. Effects of compressive lesions on intraoperative human spinal cord elasticity. J Neurosurg Spine. 2021;35(6):807\u2013816."},{"issue":"4","key":"b30","series-title":"J Neurosurg Spine","first-page":"444","article-title":"Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up","volume":"27","author":"Smith JS","year":"2017","unstructured":"Smith JS, Shaffrey CI, Klineberg E,  Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up. J Neurosurg Spine. 2017;27(4):444\u2013457."},{"issue":"3","key":"b31","series-title":"Asian Spine J","first-page":"601","article-title":"A review of complications and outcomes following vertebral column resection in adults","volume":"10","author":"Iyer S","year":"2016","unstructured":"Iyer S, Nemani VM, Kim HJ. A review of complications and outcomes following vertebral column resection in adults. Asian Spine J. 2016;10(3):601\u2013609."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2024.6.SPINE24176\/article-10.3171-2024.6.SPINE24176.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2024.6.SPINE24176\/article-10.3171-2024.6.SPINE24176.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2024.6.SPINE24176\/article-10.3171-2024.6.SPINE24176.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,28]],"date-time":"2024-12-28T02:03:46Z","timestamp":1735351426000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2024.6.SPINE24176\/article-10.3171-2024.6.SPINE24176.xml"}},"subtitle":["Presented at the 2024 AANS\/CNS Joint Section on Disorders of the Spine and Peripheral Nerves"],"short-title":[],"issued":{"date-parts":[[2024,10,1]]},"references-count":31,"URL":"https:\/\/doi.org\/10.3171\/2024.6.spine24176","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2024,10,1]]}}}