title: Outcome following multiple repeated spinal cord untethering operations.
abstract: OBJECTIVE
  Patients who have undergone prior myelomeningocele or lipomyelomeningocele repair may present with symptomatic retethering of the spinal cord. In some cases, symptomatic tethering may recur after previous untethering operations. The expected outcome following repeated untethering in a patient after two or more prior untethering operations is not well described.
  
  
  METHODS
  The authors examined surgical indications, techniques, and outcomes for 30 repeated untethering operations in 22 patients who had undergone a previous repair of the primary spinal disorder and at least two subsequent untethering operations. The mean age at repeated untethering was 12.3 years. Presenting symptoms were pain (70%), weakness (70%), urinary symptoms (57%), and sensory changes (27%). The mean duration of symptoms was 7.5 months, and a longer symptomatic interval correlated with an increased number of prior operations. Total circumferential untethering was accomplished in 11 cases (37%). Postoperative symptomatic improvement was noted most often for pain (81%), and less often for urinary symptoms (53%) and weakness (48%). Complications included postoperative cerebrospinal fluid leakage or pseudomeningocele and new postoperative lower-extremity dysesthesia in five cases (17%). An increasing number of prior untethering operations was associated with a worse result for pain relief and a greater chance of significant morbidity.
  
  
  CONCLUSIONS
  Multiple repeated untethering operations offer symptomatic relief to well-selected patients with this condition.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan 48109-0338, USA. cmaher@umich.edu
authors.forename: Cormac O
authors.initials: CO
authors.lastname: Maher
authors.forename: Lilliana
authors.initials: L
authors.lastname: Goumnerova
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Madsen
authors.forename: Mark
authors.initials: M
authors.lastname: Proctor
authors.forename: R Michael
authors.initials: RM
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D000328:Adult; D016543:Central Nervous System Neoplasms / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D008067:Lipoma / Q000601:surgery; D008591:Meningomyelocele / Q000601:surgery; D018908:Muscle Weakness / Q000209:etiology; D009436:Neural Tube Defects / Q000150:complications / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010146:Pain / Q000209:etiology; D012086:Reoperation; D012678:Sensation Disorders / Q000209:etiology; D016896:Treatment Outcome; D014555:Urination Disorders / Q000209:etiology