PMID- 31675690
OWN - NLM
STAT- Publisher
LR  - 20240227
IS  - 1933-0715 (Electronic)
IS  - 1933-0707 (Linking)
DP  - 2019 Nov 1
TI  - Predictors of surgical treatment in children with tethered fibrofatty filum 
      terminale.
PG  - 1-8
LID - 2019.8.PEDS19292 [pii]
LID - 10.3171/2019.8.PEDS19292 [doi]
AB  - OBJECTIVE: Thickened or fatty filum terminale is an occult lesion that can cause 
      tethered cord syndrome requiring surgical untethering. This study's objectives 
      were to estimate the incidence of tethered fibrofatty filum terminale (TFFT) in a 
      large insured pediatric population, identify predictors of surgery among those 
      TFFT patients, and assess a diagnostic algorithm. METHODS: TFFT was defined 
      according to the ICD-9-CM code for cord tethering (742.59), after excluding codes 
      for diastematomyelia, lipomyelomeningocele, terminal myelocystocele, meningocele, 
      and myelomeningocele. Utilizing the Optum Insight database for 2001-2014, the 
      authors identified pediatric patients (< 21 years) in the US who were diagnosed 
      with a tethered cord and estimated the TFFT incidence rates in that source 
      population and the surgical untethering probability among TFFT patients over the 
      14-year period. Logistic regression was used to estimate the effects (adjusted OR 
      and 95% CI) of age at diagnosis, sex, Charlson Comorbidity Index (CCI) score, 
      diagnosis of Chiari malformation type I, diagnosis of syrinx, and the probability 
      of surgery by US census region. Lastly, to evaluate their algorithm for 
      identifying TFFT from ICD-9 codes, the authors estimated its positive predictive 
      value (PPV) among 50 children who were diagnosed at their institution and met the 
      ICD-9-CM criteria. RESULTS: There were 3218 diagnoses of TFFT, with 482 of these 
      pediatric patients undergoing tethered cord release during the study period. The 
      estimated incidence rate was 12.0 per 100,000/year (95% CI 11.6-12.4 per 
      100,000/year). The incidence rate was slightly higher in females than in males 
      (12.7 vs 11.4 per 100,000/year). The probability of surgery in the total 
      pediatric TFFT population was 15.0% (95% CI 13.8%-16.2%) and was greater in 
      children with a syrinx (OR 2.2, 95% CI 1.6-3.0), children 7-11 years of age at 
      diagnosis versus < 1 year (OR 1.5, 95% CI 1.1-2.0), CCI score >/= 3 versus 0 (OR 
      2.3, 95% CI 1.4-3.8), and residents of the Western vs Northeastern US (OR 2.3, 
      95% CI 1.6-3.5). In the authors' own institution's database, the PPV of TFFT was 
      35/50 (70.0%, 95% CI 57.3%-82.7%) for identifying tethered cord due to fibrofatty 
      filum terminale among childhood positives. CONCLUSIONS: Patients with 
      comorbidities or an associated syrinx showed a higher risk of untethering 
      procedures for TFFT. Also, surgery was appreciably more frequent in the Western 
      US. These findings signify the need for a collaborative prospective cohort study 
      of long-term outcomes for TFFT patients with and without surgery to determine 
      which patients should have surgery.
FAU - Kashlan, Osama N
AU  - Kashlan ON
AD  - 1Department of Neurosurgery, University of Michigan.
FAU - Wilkinson, D Andrew
AU  - Wilkinson DA
AD  - 1Department of Neurosurgery, University of Michigan.
FAU - Morgenstern, Hal
AU  - Morgenstern H
AD  - 2Department of Epidemiology and Environmental Health Sciences, School of Public 
      Health; and.
AD  - 3Department of Urology, Medical School, University of Michigan, Ann Arbor, 
      Michigan.
FAU - Khalsa, Siri S
AU  - Khalsa SS
AD  - 1Department of Neurosurgery, University of Michigan.
FAU - Maher, Cormac O
AU  - Maher CO
AD  - 1Department of Neurosurgery, University of Michigan.
LA  - eng
PT  - Journal Article
DEP - 20191101
PL  - United States
TA  - J Neurosurg Pediatr
JT  - Journal of neurosurgery. Pediatrics
JID - 101463759
SB  - IM
OTO - NOTNLM
OT  - CCI = Charlson Comorbidity Index
OT  - CM-I = Chiari malformation type I
OT  - ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical 
      Modification
OT  - PPV = positive predictive value
OT  - TFFT = tethered fibrofatty filum terminale
OT  - claims analysis
OT  - epidemiology
OT  - fatty filum
OT  - fibrofatty filum
OT  - fibrous filum
OT  - filum terminale lipoma
OT  - incidence rate
OT  - regional variability
OT  - spine
OT  - tethered cord syndrome
EDAT- 2019/11/02 06:00
MHDA- 2019/11/02 06:00
CRDT- 2019/11/02 06:00
PHST- 2019/05/28 00:00 [received]
PHST- 2019/08/28 00:00 [accepted]
PHST- 2019/11/02 06:00 [entrez]
PHST- 2019/11/02 06:00 [pubmed]
PHST- 2019/11/02 06:00 [medline]
AID - 2019.8.PEDS19292 [pii]
AID - 10.3171/2019.8.PEDS19292 [doi]
PST - aheadofprint
SO  - J Neurosurg Pediatr. 2019 Nov 1:1-8. doi: 10.3171/2019.8.PEDS19292.