Surgical indication and outcome in patients with postoperative retethered cord syndrome

Hayashi, Toshiaki; Takemoto, Jun; Ochiai, Tatsuhiro; Kimiwada, Tomomi; Shirane, Reizo; Sakai, Kiyohide; Nakagawa, Haruo; Tominaga, Teiji

doi:10.3171/2012.10.peds12220

Cited by 19 publications

(18 citation statements)

References 22 publications

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“…Neurological deterioration is not a rare complication. The rate is reported as <4% in a few articles 6,18,43) and 6% (1/16 LMM re-untethering patients) in the series of Pierre-Kahn et al 34) . However, our experience shows a rate of neurological deterioration of >10%.…”

Section: Neurological Complicationsmentioning

confidence: 98%

“…The percentage of the presence of each symptom depends on the level of recognition and the alertness of the management team and caregivers. However, urological and motor symptoms tend to be more common (>50%) than others 18,26,28) . Pain is more frequent in aged children.…”

Section: Type Of Manifestationmentioning

confidence: 99%

“…According to Ostling et al 32) , retethering usually manifests 5 years after previous untethering surgery. However, the interval between the initial operation and re-untethering surgery also depends on the duration of follow-up, and the reported intervals range widely, from 2 months to more than an average of 100 months 18,27) . As stated by Al-Holou et al 3) and Goodrich et al 15) , at least the whole growing period, up to 18 years of age, seems to be a vulnerable time for retethering.…”

Section: Timing Of Symptomatic Retetheringmentioning

confidence: 99%

“…Hayashi et al 18) emphasized the importance of UDS. They found abnormalities in UDS in 98% of patients with retethering, although only 9% of them showed urinary incontinence.…”

Section: Udsmentioning

confidence: 99%

“…According to Sun et al 41) , the worsening of weakness by surgery was more likely if the symptom of retethering was motor weakness. Transient lower leg paresthesia is much more common and is reported in up to 79% of patients 18) .…”

Section: Neurological Complicationsmentioning

confidence: 99%

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Retethering : A Neurosurgical Viewpoint

Lee

Kim

Park

et al. 2020

J Korean Neurosurg Soc

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During the follow-up period after surgery for spinal dysraphism, a certain portion of patients show neurological deterioration and its secondary phenomena, such as motor, sensory or sphincter changes, foot and spinal deformities, pain, and spasticity. These clinical manifestations are caused by tethering effects on the neural structures at the site of previous operation. The widespread recognition of retethering drew the attention of medical professionals of various specialties because of its incidence, which is not low when surveillance is adequate, and its progressive nature. This article reviews the literature on the incidence and timing of deterioration, predisposing factors for retethering, clinical manifestations, diagnosis, surgical treatment and its complications, clinical outcomes, prognostic factors after retethering surgery and preventive measures of retethering. Current practice and opinions of Seoul National University Children's Hospital team were added in some parts. The literature shows a wide range of data regarding the incidence, rate and degree of surgical complications and long-term outcomes. The method of prevention is still one of the main topics of this entity. Although alternatives such as spinal column shortening were introduced, re-untethering by conventional surgical methods remains the current main management tool. Re-untethering surgery is a much more difficult task than primary untethering surgery. Updated publications include strong skepticism on re-untethering surgery in a certain group of patients, though it is from a minority of research groups. For all of the abovementioned reasons, new information and ideas on the early diagnosis, treatment and prevention of retethering are critically necessary in this era.

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Section: Neurological Complicationsmentioning

confidence: 98%

Section: Type Of Manifestationmentioning

confidence: 99%

Section: Timing Of Symptomatic Retetheringmentioning

confidence: 99%

“…Hayashi et al 18) emphasized the importance of UDS. They found abnormalities in UDS in 98% of patients with retethering, although only 9% of them showed urinary incontinence.…”

Section: Udsmentioning

confidence: 99%

Section: Neurological Complicationsmentioning

confidence: 99%

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Retethering : A Neurosurgical Viewpoint

Lee

Kim

Park

et al. 2020

J Korean Neurosurg Soc

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Clinical and urodynamic features of secondary tethered cord syndrome: How can they be found longitudinally?

Lee

Jung

et al. 2021

Neurourology and Urodynamics

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Secondary tethered cord syndrome (TCS) can be diagnosed with signs of progressive deterioration in urological or neuro-orthopedic systems following primary untethering surgery. Though urological deterioration is a common secondary TCS manifestation, a paucity of diagnostic criteria makes diagnoses challenging. A detailed description of urological deterioration may help diagnose secondary TCS. Thus, the clinical and urodynamic features of the current secondary TCS cases were described. Materials and Methods: Fifty-one patients who had undergone reuntethering for secondary TCS experienced improvement or stabilization of progressive problems. Moreover, their clinical and videourodynamic changes were longitudinally described.Results: Loss of postoperative spontaneous voiding was the first urological secondary TCS sign for those who could void spontaneously. Urological problems mostly occurred during elementary school (6-12 years). Major urological presentations were recalcitrant urinary tract infection or urinary incontinence. Follow-up videourodynamic studies revealed typical changes, from acontractile bladder to overactive and low-complaint bladders. While detrusor overactivity did not always occur during the progression, detrusor sphincter dyssynergia was always present in all patients with urological deterioration. All patients postoperatively showed significant urodynamic improvement regardless of preoperative bladder dysfunction. This included four cases of restoring spontaneous voiding. Nine patients experienced newly appearing nonprogressive neuro-orthopedic complications despite their urological improvement. Conclusions: Urological deterioration should prompt secondary TCS suspicion, and changes in clinical patterns and videourodynamic studies helped diagnose it. However, reuntethering can effectively address urological problems at the cost of some neuro-orthopedic functions in some patients.

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