Prenatal Myelomeningocele Closure Is Associated With Higher Risk Of Early Detethering Procedure For Tethered Cord- An National Spina Bifida Patient Registry study
Hsin-Hsiao Scott Wang, MD, MPH, MBAn1, Tanya Logvinenko, PhD1, Benjamin Warf, MD1, Lawrence Karliln, MD1, Stuart Bauer, MD1, Erin McNamara, MD, MPH1, John Wiener, MD2, David Chu, MD, MSc3, Robin Bowman, MD3, Charles Rose, PhD4, Tiebin Liu, PhD4, Heidi Castillo, MD5, Jonathan Castillo, MD5, Andrew Foy, MD6, Kathryn Smith, MD7, Alexander Van Speybroack, MD7, Carlos Estrada, MD, MBA1, Carlos Estrada, MD, MBA1.
1Boston Children's Hospital, Boston, MA, USA, 2Duke University Medical Center, Durham, NC, USA, 3Lurie Children's Hospital of Chicago, Chicago, IL, USA, 4Centers for Disease Control and Prevention, Atlanta, GA, USA, 5Texas Children's Hospital, Houston, TX, USA, 6Medical College of Wisconsin, Milwaukee, WI, USA, 7Children's Hospital Los Angeles, Los Angeles, CA, USA.
Introduction: Although benefits resulting from prenatal closure of myelomeningocele (MMC) have been demonstrated, its impact on future spinal cord tethering is not well known. We compared the risk for requiring TCR between children with prenatal and those with postnatal MMC repair in a large national registry.
Methods: We included children born during 1990 through 2021 who had prenatal or postnatal MMC closure and were followed in the National Spina Bifida Patient Registry (NSBPR). The main outcome was time from birth to first tethered cord release (TCR). Co-variates included race, sex, and functional level of neurologic lesion. A multivariable Cox proportional hazard model was fitted. Registry sites were included as random effects in the model to adjust for clustering.
Results: This study identified 474 children with prenatal and 6,406 children with postnatal MMC closures. There were 90 (19%) with prenatal closure and 1,281 (20%) with postnatal closure who underwent TCR. The median age for those who had TCR was 2.9 (Interquartile Range [IQR] 1.3-6.7) years in the prenatal closure group and 6 (IQR 3-10.3) years in the postnatal closure group (p<0.001). Prenatal MMC closure was associated with earlier need for TCR (Figure 1). After adjusting for sex, race, functional level of neurologic lesion, and NSBPR site, the hazard of TCR for an individual with prenatal MMC closure was twice the hazard for an individual with postnatal MMC closure (Hazard Ratio 2.0, 95% CI 1.4-2.7), p<0.001). A sensitivity analysis adding individuals born before 1990 showed similar results. CONCLUSIONS: Compared with postnatal closure, prenatal MMC closure was associated with a higher hazard for early TCR. Periodic and comprehensive monitoring of these children for signs of tethered cord should be considered.
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