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Children with tethered cord syndrome of different etiology benefit from microsurgery-a single institution experience
Pantelis Stavrinou1, Mathias Kunz, Markus Lehner
1Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
Insights
Tethered cord syndrome (TCS) management in children was studied. Surgical intervention improved pain, motor deficits, and urinary dysfunction, highlighting the importance of precise surgical indication and advanced monitoring.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Medicine
- Neurology
Background:
- Tethered cord syndrome (TCS) encompasses a spectrum of conditions characterized by abnormal stretching of the spinal cord.
- It is associated with dysraphic conditions and can present as a distinct diagnosis or a complex of symptoms.
- Limited data exists on optimal management strategies for pediatric TCS.
Purpose of the Study:
- To underscore management strategies for pediatric tethered cord syndrome.
- To discuss the results, pitfalls, and treatment outcomes in pediatric TCS patients.
- To contribute to the evidence base for TCS management.
Main Methods:
- Retrospective clinical outcome study of 20 pediatric patients.
- Included patients with closed spinal dysraphism, post-myelomeningocele repair tethering, and infected dermal sinus.
- Performed 22 detethering procedures with analysis of symptom improvement.
Main Results:
- Preoperative symptoms included muscle weakness, urinary dysfunction, foot deformities, and pain.
- Pain showed the most favorable response to surgical treatment.
- Improvement was observed in 11/15 patients with motor deficits and 11/16 with urinary dysfunction.
Conclusions:
- Optimal outcomes in pediatric TCS rely on accurate surgical indication.
- Implementation of technical advancements like intraoperative neurophysiological monitoring and ultrasound is crucial.
- Further evidence is needed to guide treatment decisions for children with TCS.
Purpose:
The term "tethered cord syndrome" (TCS) illustrates, according to the literature, both a separate diagnosis, as well as a combination of symptoms in the context of dysraphic conditions. The common denominator is the increased tension and abnormal stretching of the spinal cord, caused by tissue attachments that limit its movement in the spinal canal. In light of the fact that no real data exists regarding the management of these patients, the purpose of this single institutional study is to underscore management strategies and discuss the results, pitfalls, and the treatment of pediatric patients with tethered cord syndrome.
Methods And Results:
The clinical outcome in 20 pediatric patients was studied retrospectively. Ten children with closed spinal dysraphism, nine with tethering after postpartum myelomeningocele repair, and one child with an infected open dermal sinus were included. A total of 22 detethering procedures were performed. The most common symptoms prior to surgery were muscle weakness and urinary dysfunction, followed by foot deformities and pain. Of all symptoms, pain responded most favorably to surgical treatment. There was improvement in 11 out of 15 patients with preoperative motor deficits, while that was the case in 11 out of 16 patients with urinary dysfunction.
Conclusions:
In view of the lack of evidence regarding the treatment of children with tethered cord syndrome, the best way to aim for a favorable outcome is correct indication for surgical intervention, combined with the implementation of technical advancements, such as intraoperative neurophysiological monitoring and ultrasound.
