Inappropriate surgical interventions for midline fusion defects cause secondary tethered cord symptoms: implications for natural history report of four cases

Abstract

It looks that tethered cord symptoms invariably appear as enough negative influence accumulates as the time passes. Elapsed time may vary but unpleasant end result invariably arrives. While these cases with tethered spinal cord develop progressive neurological symptoms, prophylactic and appropriate surgical intervention should be considered as early as possible. There is no acceptable rationale to wait for the appearance of tethered cord syndrome symptoms to perform surgical untethering of the spinal cord because of the probability of irreversibility of the symptoms (incontinence of urine in particular) of tethered spinal cord syndrome.

Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children's continence society

“…This gap, combined with lack of randomized controlled trials, has produced controversy regarding indications for surgery for many OSD in asymptomatic or stable children. This debate is poignant because once deficits develop (lower extremity motor weakness, foot deformity, and/or urinary and bowel dysfunction) they are often irreversible following surgery …”

“…This debate is poignant because once deficits develop (lower extremity motor weakness, foot deformity, and/or urinary and bowel dysfunction) they are often irreversible following surgery. 24,[56][57][58] The range of surgical risks for different OSDs varies widely. Until more long-term data are available from welldesigned studies, surgeons continue to "walk the fine line between over and under treatment."…”