Application and outcomes of a standardized, evidence-based institutional approach to simple tethered cord management
Notice bibliographique
Résumé
OBJECTIVE: There is significant evidence in the literature and decades of practice experience that support filum terminale sectioning as an effective intervention to improve the symptoms of simple tethered cord (sTC). The diagnosis of sTC and indications for sTC surgery vary widely across the US and Canada, although the overall incidence of sTC surgery has been increasing across the US. This study sought to create and evaluate an evidence-based algorithm for the management of sTC. METHODS: An institutional standard for sTC management was established, based on an evidence-based medicine analysis of 93 papers from the literature. A prospective, IRB-approved study of all patients treated with these strictly delimited indications in 2019 was undertaken. Demographic, clinical, diagnostic, consultative, and outcome data were collected for all patients. Operated patients were seen at 6 weeks and 6 months for follow-up. Postoperative outcomes were recorded on a 4-point ordinal scale (worse, same, better, resolved) for analysis. RESULTS: Seven hundred twenty-nine unique patients were evaluated for possible sTC in 1 calendar year. One hundred fifty-one operations were performed. Two minor complications were noted (surgical wound breakdown and upper extremity deep vein thrombosis). All operated patients were clinically symptomatic, 79% of whom had 3 or more symptoms of sTC syndrome. Patients were seen by 3 or more subspecialists before surgery in 60% of the cases; no patient had fewer than 2 subspecialists involved in diagnosis. Postoperative results recorded by neurosurgery were strongly concordant with results observed by consultants. Significant improvement of symptomatic sTC was found across all symptoms (bladder/bowel/back pain/leg pain/gait/headache/tone) in the majority of patients. CONCLUSIONS: Filum terminale release for patients with sTC is a low-morbidity, high-impact intervention that can be beneficial to many children. A standardized set of operative indications driven by a multidisciplinary, evidence-based algorithm for sTC had high accuracy in identifying patients who benefit from a filum terminale release.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».