Symptomatic and Urodynamic Outcomes After Spinal Cord De-Tethering in Primary Tethered Cord Patients

It is controversial whether surgical correction of tethered spinal cord in non-myelomeningocele tethered cord patients results in reversal versus stabilization of urologic (GU), gastrointestinal (GI), and musculoskeletal (MSK) symptoms.

To determine factors associated with clinical improvement in symptoms after spinal cord de-tethering, and evaluate whether pre-operative urodynamic testing predicts post-operative clinical outcomes.

213 non-myelomeningocele children who underwent primary spinal cord de-tethering at a quaternary children's hospital from 2012 to 2020 were retrospectively reviewed. Age at surgery, gender, and presence of GU symptoms, constipation, MSK symptoms, and urodynamic studies were collected. Pre-operative symptoms and demographics were compared between patients with and without resolution of GU symptoms after surgery.

Mean age at surgery was 5.36 years, 48% were female, and mean length of follow up was 1.8 years. Before surgery, 133/213 (62%) experienced a GU symptom. 105/213 (49%) patients were potty-trained. Of 105 potty-trained patients, 50 (48%) had daytime incontinence and 55 (52%) had nocturnal enuresis. Of 88 potty-trained patients with urinary symptoms, 22 (25%) had resolution of and 59 (67%) had improvement following surgery. Of the 102 with constipation, 45 (44%) had improvement. Of the 116 with musculoskeletal symptoms, 60 (52%) had improvement. Patients with resolution of GU symptoms were younger (4.97 vs. 8 years, p = 0.0019). Patients with daytime urinary incontinence (p = 0.0119) were less likely to have resolution of GU symptoms. There was no difference in urodynamic findings between patients with and without improvement or resolution of urologic symptoms.

Younger age at de-tethering surgery is associated with improvement in genitourinary symptoms. Preoperative urodynamic studies may not be predictive of postoperative outcomes.