Application and outcomes of a standardized, evidence-based institutional approach to simple tethered cord management
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".