Conservative versus neurosurgical treatment of tethered cord patients

We compared the outcome of neurosurgical release of a tethered spinal cord in 20 children with the neurological evolution of 21 other children known iwth a tethered spinal cord on nuclear magnetic resonance scan (NMR). Neurosurgery yielded stabilisation of the symptoms without any lasting improvement. Pre-operative conservative medical treatment had to be continued in all operated children. Three of the 20 operated children are showing signs of retethering despite appropriate neurosurgery, indicating that retethering should be considered as a major and frequent complication. In the majority of our children, symptomatic (re)tethering was recognised by the appearance of increased tendon reflexes and a progressive pes cavus, suggestive of an upper motor neuron disease involvement.