Potential higher risk of tethered spinal cord in children after prenatal surgery for myelomeningocele: A systematic review and meta-analysis
We performed a systematic review and meta-analysis on the incidence of secondary tethered spinal cord (TSC) between prenatal and postnatal closure in patients with MMC. The objectives was to understand the incidence of secondary TSC after prenatal surgery for MMC compared to postnatal surgery for MM...
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| Veröffentlicht in: | PloS one 2023-06, Vol.18 (6), p.e0287175-e0287175 |
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| description | We performed a systematic review and meta-analysis on the incidence of secondary tethered spinal cord (TSC) between prenatal and postnatal closure in patients with MMC. The objectives was to understand the incidence of secondary TSC after prenatal surgery for MMC compared to postnatal surgery for MMC.
On May 4, 2023, a systematic search was conducted in Medline, Embase, and the Cochrane Library to gather relevant data. Primary studies focusing on repair type, lesion level, and TSC were included, while non-English or non-Dutch reports, case reports, conference abstracts, editorials, letters, comments, and animal studies were excluded. Two reviewers assessed the included studies for bias risk, following PRISMA guidelines. TSC frequency in MMC closure types was determined, and the relationship between TSC occurrence and closure technique was analyzed using relative risk and Fisher's exact test. Subgroup analysis revealed relative risk differences based on study designs and follow-up periods. A total of ten studies, involving 2,724 patients, were assessed. Among them, 2,293 patients underwent postnatal closure, while 431 received prenatal closure for the MMC defect. In the prenatal closure group, TSC occurred in 21.6% (n = 93), compared to 18.8% (n = 432) in the postnatal closure group. The relative risk (RR) of TSC in patients with prenatal MMC closure versus postnatal MMC closure was 1.145 (95%CI 0.939 to 1.398). Fisher's exact test indicated a statistically non-significant association (p = 0.106) between TSC and closure technique. When considering only RCT and controlled cohort studies, the overall RR for TSC was 1.308 (95%CI 1.007 to 1.698) with a non-significant association (p = .053). For studies focusing on children up until early puberty (maximum 12 years follow-up), the RR for tethering was 1.104 (95%CI 0.876 to 1.391), with a non-significant association (p = 0.409).
This review found no significant increase in relative risk of TSC between prenatal and postnatal closure in MMC patients, but a trend of increased TSC in the prenatal group. More long-term data on TSC after fetal closure is needed for better counseling and outcomes in MMC. |
| doi_str_mv | 10.1371/journal.pone.0287175 |
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On May 4, 2023, a systematic search was conducted in Medline, Embase, and the Cochrane Library to gather relevant data. Primary studies focusing on repair type, lesion level, and TSC were included, while non-English or non-Dutch reports, case reports, conference abstracts, editorials, letters, comments, and animal studies were excluded. Two reviewers assessed the included studies for bias risk, following PRISMA guidelines. TSC frequency in MMC closure types was determined, and the relationship between TSC occurrence and closure technique was analyzed using relative risk and Fisher's exact test. Subgroup analysis revealed relative risk differences based on study designs and follow-up periods. A total of ten studies, involving 2,724 patients, were assessed. Among them, 2,293 patients underwent postnatal closure, while 431 received prenatal closure for the MMC defect. In the prenatal closure group, TSC occurred in 21.6% (n = 93), compared to 18.8% (n = 432) in the postnatal closure group. The relative risk (RR) of TSC in patients with prenatal MMC closure versus postnatal MMC closure was 1.145 (95%CI 0.939 to 1.398). Fisher's exact test indicated a statistically non-significant association (p = 0.106) between TSC and closure technique. When considering only RCT and controlled cohort studies, the overall RR for TSC was 1.308 (95%CI 1.007 to 1.698) with a non-significant association (p = .053). For studies focusing on children up until early puberty (maximum 12 years follow-up), the RR for tethering was 1.104 (95%CI 0.876 to 1.391), with a non-significant association (p = 0.409).
This review found no significant increase in relative risk of TSC between prenatal and postnatal closure in MMC patients, but a trend of increased TSC in the prenatal group. More long-term data on TSC after fetal closure is needed for better counseling and outcomes in MMC.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0287175</identifier><identifier>PMID: 37379312</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abnormalities ; Age ; Biology and Life Sciences ; Case reports ; Children ; Cohort analysis ; Comparative analysis ; Comparative studies ; Diseases ; Female ; Fetus ; Fetuses ; Gait ; Health risks ; Humans ; Incidence ; Medical research ; Medicine and Health Sciences ; Medicine, Experimental ; Meningomyelocele - surgery ; Meta-analysis ; Neural tube ; Neurosurgical Procedures - methods ; Orthopedics ; Physical Sciences ; Pregnancy ; Pregnant women ; Puberty ; Research and Analysis Methods ; Scoliosis ; Spina bifida ; Spinal Cord ; Statistical analysis ; Subgroups ; Surgery ; Systematic review ; Tethering</subject><ispartof>PloS one, 2023-06, Vol.18 (6), p.e0287175-e0287175</ispartof><rights>Copyright: © 2023 Spoor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Spoor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Spoor et al 2023 Spoor et al</rights><rights>2023 Spoor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c693t-8677adb57a27db8b6d73c3055ef26191b76648f154cfbdc067b000b21434a923</citedby><cites>FETCH-LOGICAL-c693t-8677adb57a27db8b6d73c3055ef26191b76648f154cfbdc067b000b21434a923</cites><orcidid>0000-0003-0189-8265 ; 0000-0003-1183-4775 ; 0000-0002-9667-8486</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10306217/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10306217/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37379312$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Ukachukwu, Alvan</contributor><creatorcontrib>Spoor, Jochem K H</creatorcontrib><creatorcontrib>Kik, Charlotte C</creatorcontrib><creatorcontrib>van Veelen, Marie-Lise C</creatorcontrib><creatorcontrib>Dirven, Clemens</creatorcontrib><creatorcontrib>Miller, Jena L</creatorcontrib><creatorcontrib>Groves, Mari L</creatorcontrib><creatorcontrib>DeKoninck, Philip L J</creatorcontrib><creatorcontrib>Baschat, Ahmet A</creatorcontrib><creatorcontrib>Eggink, Alex J</creatorcontrib><title>Potential higher risk of tethered spinal cord in children after prenatal surgery for myelomeningocele: A systematic review and meta-analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>We performed a systematic review and meta-analysis on the incidence of secondary tethered spinal cord (TSC) between prenatal and postnatal closure in patients with MMC. The objectives was to understand the incidence of secondary TSC after prenatal surgery for MMC compared to postnatal surgery for MMC.
On May 4, 2023, a systematic search was conducted in Medline, Embase, and the Cochrane Library to gather relevant data. Primary studies focusing on repair type, lesion level, and TSC were included, while non-English or non-Dutch reports, case reports, conference abstracts, editorials, letters, comments, and animal studies were excluded. Two reviewers assessed the included studies for bias risk, following PRISMA guidelines. TSC frequency in MMC closure types was determined, and the relationship between TSC occurrence and closure technique was analyzed using relative risk and Fisher's exact test. Subgroup analysis revealed relative risk differences based on study designs and follow-up periods. A total of ten studies, involving 2,724 patients, were assessed. Among them, 2,293 patients underwent postnatal closure, while 431 received prenatal closure for the MMC defect. In the prenatal closure group, TSC occurred in 21.6% (n = 93), compared to 18.8% (n = 432) in the postnatal closure group. The relative risk (RR) of TSC in patients with prenatal MMC closure versus postnatal MMC closure was 1.145 (95%CI 0.939 to 1.398). Fisher's exact test indicated a statistically non-significant association (p = 0.106) between TSC and closure technique. When considering only RCT and controlled cohort studies, the overall RR for TSC was 1.308 (95%CI 1.007 to 1.698) with a non-significant association (p = .053). For studies focusing on children up until early puberty (maximum 12 years follow-up), the RR for tethering was 1.104 (95%CI 0.876 to 1.391), with a non-significant association (p = 0.409).
This review found no significant increase in relative risk of TSC between prenatal and postnatal closure in MMC patients, but a trend of increased TSC in the prenatal group. More long-term data on TSC after fetal closure is needed for better counseling and outcomes in MMC.</description><subject>Abnormalities</subject><subject>Age</subject><subject>Biology and Life Sciences</subject><subject>Case reports</subject><subject>Children</subject><subject>Cohort analysis</subject><subject>Comparative analysis</subject><subject>Comparative studies</subject><subject>Diseases</subject><subject>Female</subject><subject>Fetus</subject><subject>Fetuses</subject><subject>Gait</subject><subject>Health risks</subject><subject>Humans</subject><subject>Incidence</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Medicine, Experimental</subject><subject>Meningomyelocele - surgery</subject><subject>Meta-analysis</subject><subject>Neural tube</subject><subject>Neurosurgical Procedures - methods</subject><subject>Orthopedics</subject><subject>Physical Sciences</subject><subject>Pregnancy</subject><subject>Pregnant 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one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Spoor, Jochem K H</au><au>Kik, Charlotte C</au><au>van Veelen, Marie-Lise C</au><au>Dirven, Clemens</au><au>Miller, Jena L</au><au>Groves, Mari L</au><au>DeKoninck, Philip L J</au><au>Baschat, Ahmet A</au><au>Eggink, Alex J</au><au>Ukachukwu, Alvan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Potential higher risk of tethered spinal cord in children after prenatal surgery for myelomeningocele: A systematic review and meta-analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-06-28</date><risdate>2023</risdate><volume>18</volume><issue>6</issue><spage>e0287175</spage><epage>e0287175</epage><pages>e0287175-e0287175</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>We performed a systematic review and meta-analysis on the incidence of secondary tethered spinal cord (TSC) between prenatal and postnatal closure in patients with MMC. The objectives was to understand the incidence of secondary TSC after prenatal surgery for MMC compared to postnatal surgery for MMC.
On May 4, 2023, a systematic search was conducted in Medline, Embase, and the Cochrane Library to gather relevant data. Primary studies focusing on repair type, lesion level, and TSC were included, while non-English or non-Dutch reports, case reports, conference abstracts, editorials, letters, comments, and animal studies were excluded. Two reviewers assessed the included studies for bias risk, following PRISMA guidelines. TSC frequency in MMC closure types was determined, and the relationship between TSC occurrence and closure technique was analyzed using relative risk and Fisher's exact test. Subgroup analysis revealed relative risk differences based on study designs and follow-up periods. A total of ten studies, involving 2,724 patients, were assessed. Among them, 2,293 patients underwent postnatal closure, while 431 received prenatal closure for the MMC defect. In the prenatal closure group, TSC occurred in 21.6% (n = 93), compared to 18.8% (n = 432) in the postnatal closure group. The relative risk (RR) of TSC in patients with prenatal MMC closure versus postnatal MMC closure was 1.145 (95%CI 0.939 to 1.398). Fisher's exact test indicated a statistically non-significant association (p = 0.106) between TSC and closure technique. When considering only RCT and controlled cohort studies, the overall RR for TSC was 1.308 (95%CI 1.007 to 1.698) with a non-significant association (p = .053). For studies focusing on children up until early puberty (maximum 12 years follow-up), the RR for tethering was 1.104 (95%CI 0.876 to 1.391), with a non-significant association (p = 0.409).
This review found no significant increase in relative risk of TSC between prenatal and postnatal closure in MMC patients, but a trend of increased TSC in the prenatal group. More long-term data on TSC after fetal closure is needed for better counseling and outcomes in MMC.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>37379312</pmid><doi>10.1371/journal.pone.0287175</doi><tpages>e0287175</tpages><orcidid>https://orcid.org/0000-0003-0189-8265</orcidid><orcidid>https://orcid.org/0000-0003-1183-4775</orcidid><orcidid>https://orcid.org/0000-0002-9667-8486</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2023-06, Vol.18 (6), p.e0287175-e0287175 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2830601759 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Abnormalities Age Biology and Life Sciences Case reports Children Cohort analysis Comparative analysis Comparative studies Diseases Female Fetus Fetuses Gait Health risks Humans Incidence Medical research Medicine and Health Sciences Medicine, Experimental Meningomyelocele - surgery Meta-analysis Neural tube Neurosurgical Procedures - methods Orthopedics Physical Sciences Pregnancy Pregnant women Puberty Research and Analysis Methods Scoliosis Spina bifida Spinal Cord Statistical analysis Subgroups Surgery Systematic review Tethering |
| title | Potential higher risk of tethered spinal cord in children after prenatal surgery for myelomeningocele: A systematic review and meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T16%3A02%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Potential%20higher%20risk%20of%20tethered%20spinal%20cord%20in%20children%20after%20prenatal%20surgery%20for%20myelomeningocele:%20A%20systematic%20review%20and%20meta-analysis&rft.jtitle=PloS%20one&rft.au=Spoor,%20Jochem%20K%20H&rft.date=2023-06-28&rft.volume=18&rft.issue=6&rft.spage=e0287175&rft.epage=e0287175&rft.pages=e0287175-e0287175&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0287175&rft_dat=%3Cgale_plos_%3EA755001172%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2830601759&rft_id=info:pmid/37379312&rft_galeid=A755001172&rft_doaj_id=oai_doaj_org_article_e88f26e81a254e7aad819d71275f02f1&rfr_iscdi=true |