Tethered cord release: a long-term study in 114 patients

Area of Science:

• Pediatric Neurosurgery
• Spinal Cord Medicine
• Congenital Malformations

Background:

• Myelomeningocele is a complex congenital condition requiring ongoing management.
• Shunt malfunction and spinal cord tethering are common causes of functional decline in these patients.
• Symptomatic spinal cord tethering requires timely diagnosis and intervention.

Purpose of the Study:

• To review indicators of symptomatic spinal cord tethering in children with myelomeningocele.
• To discuss surgical interventions and outcomes for tethered cord release.
• To evaluate the long-term functional impact of untethering procedures.

Main Methods:

• Retrospective review of 502 children with myelomeningocele treated between 1975 and 2008.
• Analysis of 114 patients (23%) who developed symptomatic tethered cord.
• Evaluation of indicators including scoliosis, motor strength, spasticity, gait, and urological function.

Main Results:

• Pain resolved in 100% of patients post-surgery.
• 70% showed improved lower-extremity motor strength; gait also improved.
• 52% experienced scoliosis progression, with 28% needing spinal fusion; 64% had improved bladder function.

Conclusions:

• Tethered cord release is beneficial for maintaining neurological, urological, and orthopedic function in children with myelomeningocele.
• While scoliosis progression is a concern, untethering offers significant functional improvements.
• The study highlights the importance of monitoring and intervening in spinal cord tethering.