The results of surgical treatment of the tethered spinal cord syndrome in twenty-five children in the age range six weeks to nineteen years are reported. After a description of the symptomatology, the importance of neuroradiologic investigations including myelography and CT-scanning as well as urodynamic studies are explained. The operative techniques are described in cases of tight filum terminale, lipoma of the filum terminale, diastematomyelia, lipomyelomeningocele and meningocele. Early operation is essential to avoid the neurological damage which results from awaiting the onset of symptoms. The aim of the operation is to free the conus medullaris and cauda equina before mechanical traction or compression damages function in lumbosacral cord.

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The results of this study confirm the hypothesis that the simple innocuous Doppler LP test may be useful in obtaining information about CSFP-CBF (cerebrospinal fluid pressure-cerebral blood flow) relationships. The value of this test in predicting the clinical outcome of CSF shunting in patients with normal pressure hydrocephalus (NPH) was studied. Fourteen patients with NPH were examined; eight patients showed a positive and six patients a negative Doppler LP test. Seven of the eight patients with a positive test improved following the shunting procedure, but none of the six patients improved after operation. This study suggests that the Doppler LP test is a useful preoperative selection test in patients with NPH. In addition this study supports the hypothesis that CBF autoregulation may be impaired with NPH.

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