The incidence and effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele: a population-based study

View More View Less
  • Department of Neurosurgery, Center for Experimental Neuroscience–Spine, Aarhus University Hospital, Aarhus, Denmark
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The goal of this study was to establish an incidence and assess the effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele.

METHODS

The study population was based on the Western Denmark Myelomeningocele Database, which contains all patients born with myelomeningocele in western Denmark since 1970. The study population was cross-referenced in 2015 with a database for surgical procedures containing all surgical procedures performed in the central Denmark region since 1996. Patients alive between 1996 and 2015 were identified. Incidences was calculated and presented for year of age. File reviews were conducted for all patients who underwent the procedure. Follow-up was divided into short-term and long-term follow-up.

RESULTS

One hundred sixty-six patients were alive during various time periods between 1996 and 2015. Of these, 45 patients underwent the procedure. Seven underwent reoperation. The median age for the procedure was 12 years and the highest incidence was found at 15 years of age. Incidence was bimodal with highest incidence in children and adolescents. The most common indications were progressive spine deformity (40%), deteriorating ambulation (38%), and deteriorating neurogenic bladder and/or bowel dysfunction (32%). The mean short-term follow-up was 4.7 months and the mean long-term follow-up was 72.6 months. Postoperatively, the majority had improved (27%) or stabilized (27%) at short-term follow-up. At long-term follow-up, most patients were stable (27%) or had deteriorated (24%). For both follow-up terms there was a loss of approximately one-third of all patients. Complications occurred in 17% of the procedures.

CONCLUSIONS

In this population-based study, tethered cord release has the highest incidence in children and adolescents. The beneficial effect of the procedure seems to be short term. Due to the uncertainty of a long-term effect of the procedure in patients with myelomeningocele and the registered complications, the authors suggest that this surgical indication should be reserved for well-selected patients.

ABBREVIATIONS TCR = tethered cord release.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Joel Haakon Borgstedt-Bakke: Aarhus University Hospital, Aarhus, Denmark. joel.bakke@rm.dk.

INCLUDE WHEN CITING Published online May 29, 2020; DOI: 10.3171/2020.4.PEDS19722.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Copp AJ, Adzick NS, Chitty LS, Spina bifida. Nat Rev Dis Primers. 2015;1:15007.

  • 2

    Bodin CR, Rasmussen MM, Tabor A, Ultrasound in prenatal diagnostics and its impact on the epidemiology of spina bifida in a national cohort from Denmark with a comparison to Sweden. BioMed Res Int. 2018;2018:9203985.

    • Search Google Scholar
    • Export Citation
  • 3

    Borgstedt-Bakke JH, Fenger-Gron M, Rasmussen MM. Correlation of mortality with lesion level in patients with myelomeningocele: a population-based study. J Neurosurg Pediatr. 2017;19(2):227231.

    • Search Google Scholar
    • Export Citation
  • 4

    Herman JM, McLone DG, Storrs BB, Dauser RC. Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord. Presentation, management and outcome. Pediatr Neurosurg. 1993;19(5):243249.

    • Search Google Scholar
    • Export Citation
  • 5

    McLone DG, Herman JM, Gabrieli AP, Dias L. Tethered cord as a cause of scoliosis in children with a myelomeningocele. Pediatr Neurosurg. 1990-1991;16(1):813.

    • Search Google Scholar
    • Export Citation
  • 6

    Bowman RM, Mohan A, Ito J, Tethered cord release: a long-term study in 114 patients. J Neurosurg Pediatr. 2009;3(3):181187.

  • 7

    Mehta VA, Bettegowda C, Ahmadi SA, Spinal cord tethering following myelomeningocele repair. J Neurosurg Pediatr. 2010;6(5):498505.

  • 8

    Mehta VA, Bettegowda C, Amin A, Impact of tethered cord release on symptoms of Chiari II malformation in children born with a myelomeningocele. Childs Nerv Syst. 2011;27(6):975978.

    • Search Google Scholar
    • Export Citation
  • 9

    Behaine J, Abdel Latif AM, Greenfield JP. Fecal incontinence as a predominant symptom in a case of multiply recurrent tethered cord: diagnosis and operative strategies. J Neurosurg Pediatr. 2015;16(6):748751.

    • Search Google Scholar
    • Export Citation
  • 10

    Tarcan T, Onol FF, Ilker Y, Does surgical release of secondary spinal cord tethering improve the prognosis of neurogenic bladder in children with myelomeningocele? J Urol. 2006;176(4 Pt 1):16011606. Published correction appears in J Urol. 2006;176(6 Pt 1):2749.

    • Search Google Scholar
    • Export Citation
  • 11

    Beaumont A, Muszynski CA, Kaufman BA. Clinical significance of terminal syringomyelia in association with pediatric tethered cord syndrome. Pediatr Neurosurg. 2007;43(3):216221.

    • Search Google Scholar
    • Export Citation
  • 12

    Milhorat TH, Bolognese PA, Nishikawa M, Association of Chiari malformation type I and tethered cord syndrome: preliminary results of sectioning filum terminale. Surg Neurol. 2009;72(1):2035.

    • Search Google Scholar
    • Export Citation
  • 13

    Yamada S, Won DJ, Yamada SM. Pathophysiology of tethered cord syndrome: correlation with symptomatology. Neurosurg Focus. 2004;16(2):E6.

    • Search Google Scholar
    • Export Citation
  • 14

    Al-Holou WN, Muraszko KM, Garton HJ, The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome. J Neurosurg Pediatr. 2009;4(1):2836.

    • Search Google Scholar
    • Export Citation
  • 15

    Geyik M, Alptekin M, Erkutlu I, Tethered cord syndrome in children: a single-center experience with 162 patients. Childs Nerv Syst. 2015;31(9):15591563.

    • Search Google Scholar
    • Export Citation
  • 16

    Shurtleff DB, Duguay S, Duguay G, Epidemiology of tethered cord with meningomyelocele. Eur J Pediatr Surg. 1997;7(suppl 1):711.

  • 17

    Rocque BG, Bishop ER, Scogin MA, Assessing health-related quality of life in children with spina bifida. J Neurosurg Pediatr. 2015;15(2):144149.

    • Search Google Scholar
    • Export Citation
  • 18

    Wang JC, Lai CJ, Wong TT, Health-related quality of life in children and adolescents with spinal dysraphism: results from a Taiwanese sample. Childs Nerv Syst. 2013;29(9):16711679.

    • Search Google Scholar
    • Export Citation
  • 19

    Statistics Denmark. Population and elections. Accessed April 20, 2020. https://www.statbank.dk/10021

    • Export Citation
  • 20

    Olsson I, Dahl M, Mattsson S, Medical problems in adolescents with myelomeningocele (MMC): an inventory of the Swedish MMC population born during 1986-1989. Acta Paediatr. 2007;96(3):446449.

    • Search Google Scholar
    • Export Citation
  • 21

    Bowman RM, McLone DG, Grant JA, Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg. 2001;34(3):114120.

  • 22

    Cochrane DD, Rassekh SR, Thiessen PN. Functional deterioration following placode untethering in myelomeningocele. Pediatr Neurosurg. 1998;28(2):5762.

    • Search Google Scholar
    • Export Citation
  • 23

    Pierz K, Banta J, Thomson J, The effect of tethered cord release on scoliosis in myelomeningocele. J Pediatr Orthop. 2000;20(3):362365.

    • Search Google Scholar
    • Export Citation
  • 24

    Tamaki N, Shirataki K, Kojima N, Tethered cord syndrome of delayed onset following repair of myelomeningocele. J Neurosurg. 1988;69(3):393398.

    • Search Google Scholar
    • Export Citation
  • 25

    Daniel JW, Botelho RV, Milano JB, Intraoperative neurophysiological monitoring in spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2018;43(16):11541160.

    • Search Google Scholar
    • Export Citation
  • 26

    Ibrahim T, Mrowczynski O, Zalatimo O, The impact of neurophysiological intraoperative monitoring during spinal cord and spine surgery: a critical analysis of 121 cases. Cureus. 2017;9(11):e1861.

    • Search Google Scholar
    • Export Citation
  • 27

    Dulfer SE, Drost G, Lange F, Long-term evaluation of intraoperative neurophysiological monitoring-assisted tethered cord surgery. Childs Nerv Syst. 2017;33(11):19851995.

    • Search Google Scholar
    • Export Citation
  • 28

    Lew SM, Kothbauer KF. Tethered cord syndrome: an updated review. Pediatr Neurosurg. 2007;43(3):236248.

  • 29

    Lad SP, Patil CG, Ho C, Tethered cord syndrome: nationwide inpatient complications and outcomes. Neurosurg Focus. 2007;23(2):E3.

Metrics

All Time Past Year Past 30 Days
Abstract Views 254 254 88
Full Text Views 35 35 7
PDF Downloads 28 28 8
EPUB Downloads 0 0 0