Adult tethered cord syndrome in patients with postrepair myelomeningocele: an evidence-based outcome study

Abstract

Analysis of the available data indicates the following. (1) A lower lesion level predisposes patients to symptomatic tethering; moreover, orthopedic and urological deterioration will occur in the majority of these patients. (2) Tethered cord release should be considered for adult patients with postrepair myelomeningocele when clinical symptoms, imaging studies, urodynamics, and somatosensory evoked potentials are consistent with TCS. (3) Prompt, aggressive untethering surgery within 5 years of symptom onset, along with long-term follow up to check for delayed retethering, is recommended. The overall outcome for patients with postrepair myelomeningocele may not be as good as the outcome for adults with closed dysraphism.

Effect of detethering on bladder function in children with myelomeningocele: Urodynamic evaluation

“…This compares favorably to previous reports, in which improvement of urological symptoms has been described. [1378] However, none of them, in our study or in the previous studies, became urologically normal. [4] This could be explained by the fact that during complex microsurgery performed in those patients, the conus medullaris and the roots that innervate the lower limbs, bladder, and bowel were inevitably exposed to some degree of damage.…”

“…[16] Surgical untethering of the cord is recommended by many authors. [137–9] However, while patients with lipomyelomeningocele have the most favorable prognosis,[518] secondary tethering of the cord have a worse prognosis, and it becomes even worse with surgical treatment, as reported by Grass et al . [4]…”

“…[1] It could be primary as in the case of spinal dysraphism,[2] or secondary, following repair of the myelomeningocele. [3] In the primary case, tethering may result from an inelastic structure anchoring the caudal end of the cord as a short and thick filum terminale, while secondary tethering is produced by a scar in the area of the dysraphism resulting from postpartum surgical closure of the lesion,[4] which in turn does not permit normal cranial migration of the conus within the vertebral canal,[2] and leads to axonal anoxia resulting in neural dysfunction. [5] Clinically, this syndrome manifests itself by progressive neurological, urological, and orthopedic signs and symptoms.…”

“…[6] Many studies have reported an improvement of urodynamic, and clinical variables after the untethering procedure. [37–9] However, other studies have raised suspicion about the usefulness of such a treatment in adults. [236] Improvement of preoperative urological symptoms such as incontinence or abnormal urodynamic findings have been previously reported to be 38 and 100%, respectively, in two different studies.…”

“…[37–9] However, other studies have raised suspicion about the usefulness of such a treatment in adults. [236] Improvement of preoperative urological symptoms such as incontinence or abnormal urodynamic findings have been previously reported to be 38 and 100%, respectively, in two different studies. [810] The impact of untethering of the cord on fecal incontinence has not gained much attention.…”