Tethered cord syndrome in children - impact of surgical treatment on functional neurological and urological outcome

Background and purpose: Tethered cord syndrome (TCS) consists of solid adhesion of the distal spinal cord to adjacent structures, resulting in repetitive spinal cord traction during truncal movements. The condition is usually a sequel of lumbosacral dysraphism, spinal cord injury or surgical procedure. Clinical signs of TCS include sphincter disturbances, lumbosacral pain, sensorimotor deficits and orthopaedic deformity The aim of this study was to assess long-term results of surgical treatment of TCS in children and to define any prognostic factors associated with long-term outcome. Material and methods: Between 1980 and 2005, we treated 59 children with TCS. The group included 22 boys and 37 girls (mean age at surgery: 7.7 years). In total, 75 surgical procedures were performed. Mean follow-up time was 4.4 years. Results: Meaningful clinical improvement was obtained in 19 children (32.2%) and was more pronounced in lower extremities than in sphincters. Degree of untethering was the only factor significantly influencing outcome. Neither age at surgery nor seventy of spinal cord traction had any prognostic value. Significant correlations were found between severity of pre-existing myelopathy and development of neurogenic bladder, independently of treatment instituted. There was no permanent morbidity and perioperative mortality was nil. Conclusions: Late results of surgical treatment of TCS in children are generally unsatisfactory - worthwhile improvement was obtained in about 1/3 of patients only. Improvement was more pronounced in lower extremities than in sphincters. The sole factor contributing to good functional outcome was complete untethering of the cord. The decision whether to operate on a child with TCS must be based on coherent clinical, radiological and urological premises; surgery should be performed before irreversible deficits appear.