Management of tethered spinal cord in symptomatie and asymptomtic children

الملخص EN

Objectives.

Based on the observation that reversal of upper motor neuron dysfunction are be poor once neurological symptoms are detected, prophylactic release of the tethered spinal cord is advocated.

Twenty-two patients with tethered cord (TC) due to occult spinal dysraphism (OSD) with or without neurological deficits were operated upon for cord untethering.

Preoperative data (Clinical and radiological), operative, and outcome data were retrospectively analysed to evaluate efficacy of cord release in TC.

Methods.

Ten boys and 12 girls presented with TC, eleven of them (50%) children were symptomatic and eleven (50%) were asymptomatic.

Fourteen children (63.6%) presented with spinal lipoma, 3 (13.6%) with type ا split cord malformation (SCM), 2 (9.1%) with congenital dermal sinus (CDS), 2 (9.1%) with thick filum tenninale, and one (4.6%) with dermoid.

Age at surgery ranged from 3 months to 15 years.

Surgery consisted of releasing the cord from any tethering factors, watertight durai closure, and lumbar fascia reconstruction.

During follow-up; asymptomatic children remained unchanged, where 2 (18.2%) symptomatic children had complete recovery, 5 (45.5%) children showed partial reversal of their symptoms and 4 (36.6%) remained unchanged.

Reported morbidity included transient radicular weakness in two children, and persistent partial foot drop in one.

Conclusions.

Any signs of occult spinal dysraphism justify a thorough neurological and neuroradiological assessment.

MR1 is the examination of choice for demonstration of entire spectrum of intraspinal anatomy and spinal dysraphism.

Prophylactic release of tethered cord is mandatory, safe, and does in most cases prevent the ongoing damage from flexion / extension injury the distal spinal cord.