Surgical Outcome of Children and Adolescents with Tethered Cord Syndrome

Abstract

Study DesignRetrospective cohort study.PurposeTo compare long-term results of surgery with the outcomes of symptomatic and asymptomatic tethered cord syndrome (TCS) in children and adolescents and to assess the surgery duration for those with TCS.Overview of LiteraturePediatric patients with TCS continue to pose significant diagnostic and management challenges.MethodsWe retrospectively analyzed the outcomes of 31 patients (16 males, 15 females) with TCS, including 21 with lumbosacral lipoma. All were surgically treated between 1989 and 2015. They were divided into symptomatic and asymptomatic TCS groups. The results of the treatment were summarized and analyzed using a non-parametric Mann–Whitney U test.ResultsNineteen patients had symptomatic TCS and 12 had asymptomatic TCS. Patients had a median age of 34 months (range, 0–201 months). The median follow-up period was 116 months (range, 7–223 months). Of the 19 symptomatic TCS patients, preoperative deficits improved after surgery in two (10.5%) and remained stable in 17 (89.5%) patients. One of the 12 asymptomatic TCS (8.3%) patients showed an exacerbated illness after surgery, and one in 11 patients remained stable (11.7%). There were significant differences in monthly age at surgery, preoperative bowel and bladder dysfunction, neurological function, presence/absence of clean intermittent catheterization introduction, and presence/absence of motor disorder at final follow-up (all p<0.05). In the univariate analysis, the presence/absence of preoperative bowel and bladder dysfunction, and symptoms were strongly associated with the risk of children and adolescents with TCS (p<0.05).ConclusionsEarly accurate diagnosis and adequate surgical release might lead to successful outcomes in children and adolescents with TCS. Surgical untethering is a safe and effective method for treatment of children with TCS.

Surgical Outcomes of Pediatric Patients with Asymptomatic Tethered Cord Syndrome

“…Kanev and Bierbrauer [ 8 ] retrospectively analyzed children with lipomeningocele and showed that the incidence of neurological symptoms increased with increasing age. Regarding the surgical timing for asymptomatic TCS, Seki et al [ 9 ] reviewed 31 pediatric patients with TCS and reported that patients with asymptomatic TCS underwent surgery significantly earlier than patients with symptomatic TCS ( p =0.045). In addition, Hoffman et al [ 10 ] examined 97 patients with lipomyelomeningocele and found that 62.5% of patients aged >6 months who underwent prophylactic surgery remained asymptomatic, whereas 70.7% of those aged >6 months who underwent prophylactic surgery became symptomatic.…”

Towards Guideline-Based Management of Tethered Cord Syndrome in Spina Bifida: A Global Health Paradigm Shift in the Era of Prenatal Surgery

“…[39][40][41] Among surgical studies (n = 12), there was no clear or standardized description in the untethering technique utilized. [30][31][32][33][34]37,38,[42][43][44] Among these surgical studies, only 6 described their complications in the results section of the respective article. Additionally, 5 out of the 13 studies did not provide information on the length of follow-up after surgical intervention.…”

“…31,[38][39][40] Our findings suggest that among studies conducted in this region, the management of TCS was aggressive in the surgical approach leading to untethering and often did not rely on the pres-ence of progressive neurologic deficits as a criterion for initial surgical treatment of spinal cord tethering. 30,33,34,42 To address the observable variation in the diagnostic criteria for TCS, Lew and Kothbauer 26 defined TCS as "a diverse clinical entity which presents with symptoms and signs resulting from abnormal spinal cord tension. " They advocated that surgical untethering was only necessary in cases with progressive or new-onset symptomatology attributable to TCS and raised questions regarding the benefits of surgical untethering among asymptomatic individuals.…”

Tethered cord syndrome: surgical outcome of 43 cases and review of literatures

“…Haro et al [16] reported that adults showed better improvement in neurological and urinary problems than natal or juvenile onset tethered cord syndrome. Seki et al [17] mentioned that age at surgery is not significantly associated with prognosis. Tethered cord syndrome may have different curative effect after surgery according to the cause.…”