The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome

Clinical article

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Object

After primary repair of a myelomeningocele or a lipomyelomeningocele, patients can present with symptoms of secondary tethered cord syndrome (TCS). After surgical untethering, a small percentage of these patients can present with multiple repeat TCS. In patients presenting with secondary or multiple repeat TCS, the role as well the expected outcomes of surgical untethering are not well defined.

Methods

Eighty-four patients who underwent spinal cord untethering after at least 1 primary repair were retrospectively evaluated using scaled and subjective outcome measures at short-term and long-term follow-up visits. Outcomes were analyzed for predictive measures using multivariate logistic regression.

Results

Surgical untethering was performed in 66 patients with myelomeningoceles and 18 patients with lipomyelomeningoceles. Fourteen patients underwent multiple repeat spinal cord untethering. Patients were followed up for an average of 6.2 years. Most patients had stability of function postoperatively. Motor function and weakness improved in 7 and 16% of patients at 6 months, respectively, and 6 and 19% of patients at long-term follow-up evaluation, respectively. Of the patients who presented with back pain, 75% had improvement in symptoms at 6 months postoperatively. Younger age at untethering was significantly associated with worse long-term neurological outcomes. The number of previous untethering procedures, original diagnosis, sex, anatomical level, and degree of untethering had no effect on surgical outcomes.

Conclusions

Patients presenting with secondary or multiple repeat TCS may benefit from surgical untethering.

Abbreviations used in this paper: LMM = lipomyomeningocele; MM = myelomeningocele; NEM = Necker-Enfants Malades; TCS = tethered cord syndrome.

Article Information

Address correspondence to: Cormac O. Maher, M.D., Department of Neurosurgery, University of Michigan Health System, 1500 East Medical Center Drive, Room 3552, Taubman Center, Ann Arbor, Michigan 48109-5338. email: cmaher@med.umich.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Histogram showing patient age and frequency of surgical untethering. A line interpolated through the data points is shown. Age is presented in years.

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    Bar chart illustrating back pain outcomes at 6 months, 1 year, and at extended follow-up evaluation by percentage. A table is also incorporated, displaying outcomes at each time point by frequency of cases.

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