Surgical Outcomes of Pediatric Patients with Asymptomatic Tethered Cord Syndrome

Abstract

Study DesignA retrospective cohort study.Purpose To examine the validity of prophylactic surgery for children with tethered cord syndrome (TCS).Overview of LiteratureProphylactic surgery for pediatric patients with TCS remains controversial.Methods We retrospectively analyzed the surgical outcomes of 14 children (nine boys and five girls) with asymptomatic TCS who were surgically treated at Hokkaido University Hospital between 1989 and 2015.ResultsThe median age at the time of initial surgery for asymptomatic TCS was 28.6 months (range, 0–66 months). The median final follow-up period was 142 months (range, 7–232 months). Of the 14 children with asymptomatic TCS, 12 had lumbosacral lipoma and two had meningocele. According to the classification of spinal lipoma, two children had dorsal type, four had caudal type, two had transitional type, and four had filar type. There were no children with lipomyelomeningocele. All children were free of neurological symptoms until 94 months after the initial surgery. Subsequently, one child exhibited delayed neurological deficits and underwent a second surgery because of motor and sensory disturbances; slight sensory disturbance was noted at the final follow-up examination. Another child later showed bowel and bladder dysfunction. However, a second surgery was not performed for this child because his motor and sensory functions were normal; hence, we chose to avoid nerve injury in the case of dissecting adhesion.ConclusionsAll 14 children with asymptomatic TCS were free of neurological symptoms until 94 months after the initial surgery. However, two children exhibited delayed neurological deficits at 94 months and 177 months. We believe that prophylactic surgery for asymptomatic TCS is effective for a certain period. However, because the natural history of TCS is poorly understood, strict follow-up after surgery is necessary.

Filum terminale transection in pediatric tethered cord syndrome: a single center, population-based, cohort study of 95 cases

“…Sensorimotor symptoms were present in 74% of the symptomatic patients; all patients with sensory deficits had a simultaneous motor deficit. These findings are in accordance with previously published reports [ 13 ].…”

Surgical outcome of pediatric patients with symptomatic tethered cord syndrome at a tertiary care hospital

“…1 It occurs because spinal cord is anchored with the surrounding structures like dura, lipoma, tumor, scar tissue and adhesions. 2 Tethering causes abnormal stretch on the distal cord resulting into aggravation of symptoms. 3 These symptoms abruptly appear during growth spurt phase of the children.…”

“…Tethered cord is a disorder which refers to the hitching of the spinal cord to the structures within the spine such as dura, scar tissue, a bony spur or a lipoma of the cord. 1,2 If it is related to spinal cord dysplasia, it is classified as primary, and if it develops after surgery on the back, it is classified as secondary. 3 Primary tethering is usually from an inelastic short, thick filum which is tethering the cord caudal end as a short & thickened filum terminal.…”

Tethered cord syndrome from pediatric and adult perspectives: a comprehensive systematic review of 6135 cases

“…However, there is some debate regarding surgical treatment for asymptomatic TCS discovered during physical examination. 20 Some studies included in this review also involved asymptomatic TCS patients who underwent surgical treatment, 57 and the results showed that most patients remained asymptomatic for 5-10 years, while a small number experienced symptoms due to postoperative adhesions. 58 TCS presents a complex array of clinical symptoms, and the degree of symptomatic improvement following treatment can vary.…”