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Secondary untethering and re-untethering are both beneficial in adult tethered cord syndrome: a single-center cohort
Luisa Mona Kraus1, Maria Wostrack1,2, Bernhard Meyer1
1Department of Neurosurgery, School of Medicine and Health, Klinikum Rechts Der Isar, University Hospital of TUM, Ismaningerstraße 22, Munich, 81675, Germany.
Introduction:
Adult tethered cord syndrome (TCS) represents a heterogeneous group of congenital and acquired conditions. While primary untethering is an established treatment, re-untethering remains controversial because of concerns regarding limited neurological benefit and increased complication rates.
Research Question:
This study evaluates neurological outcomes after adults re-untethering surgery and identifies perioperative factors associated with clinical improvement.
Methods:
We performed a retrospective single-center cohort analysis of all patients surgically treated for TCS between 2008 and 2024. Patients were dichotomized into primary untethering and secondary re-untethering groups. Neurological status was assessed using the McCormick grade. Neurological improvement was defined as improvement of ≥1 McCormick grade. Postoperative complications and revision surgeries were recorded. Age and affected spinal level were analyzed as potential modifiers of outcome.
Results:
Seventy-one patients were included (median age 51.5 years); 42 underwent primary untethering and 29 re-untethering. Patients undergoing re-untethering presented with significantly worse baseline neurological status. Neurological improvement at discharge was more frequent after primary untethering (52.4% vs. 31.0%), but this difference reversed at follow-up, with higher improvement rates after secondary re-untethering (68.4% vs. 61.5%). Neither age nor affected spinal level significantly influenced neurological outcome or revision rates. Re-untethering was associated with more complex surgeries, and higher wound-healing complication rates.
Discussion And Conclusion:
Despite worse baseline neurological status, re-untethering is not associated with inferior neurological outcomes compared with primary untethering. Neurological improvement appears to be a time-dependent process, and baseline impairment alone should not preclude surgical intervention. Re-untethering in adult patients should therefore be considered on an individual basis.
