Tethered spinal cord following repair of myelomeningocele.
OBJECTIVE
The goal of this paper is to elucidate the clinical presentation of tethered cord syndrome (TCS) following repair of a myelomeningocele.


METHODS
Approximately 10 to 30% of children will develop TCS following repair of a myelomeningocele. Because essentially all children with repaired myelomeningocele will have a tethered spinal cord, as demonstrated on MR imaging, the diagnosis of TCS is made based on clinical criteria. The six common clinical presentations of TCS are increased weakness (55%), worsening gait (54%), scoliosis (51%), pain (32%), orthopedic deformity (11%), and urological dysfunction (6%). The primary goal of surgery is to detach the spinal cord where it is adherent to the thecal sac, relieving the stretch on the terminal portion of the cord.


CONCLUSIONS
Early diagnosis and surgical release of the tethered cord results in stabilization or improvement in most cases. Because TCS may present with orthopedic and/or urological signs or symptoms, children with myelomeningocele should by followed, ideally in a multidisciplinary clinic, by neurosurgeons, orthopedic surgeons, and urologists who are aware of this condition.
Hudgins
Roger J
RJ
Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Gilreath
C Lynn
CL
D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical; D018450:Disease Progression; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008591:Meningomyelocele / Q000601:surgery*; D018908:Muscle Weakness / Q000209:etiology; D009436:Neural Tube Defects / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D010146:Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D012600:Scoliosis / Q000209:etiology; D013314:Stress, Mechanical; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology