title: Tethered spinal cord syndrome--the importance of time for outcomes.
abstract: OBJECTIVE
  Tethered spinal cord syndrome is a relatively uncommon disorder of the medullary spine, usually associated with other congenital diseases of the caudal end of the spinal cord. However, it often remains unrecognised and due to its progressive character has serious consequences for those affected.
  
  
  METHODS
  We analysed a group of 22 patients, treated for TTS during the period from 1990 to 2005, focussing on the time period between the onset of symptoms and their treatment. The initial data from the year 1998 already pinpointed this time-lag as a crucial prognostic factor for outcomes.
  
  
  RESULTS
  Nine of the 22 treated patients showed an improvement of symptoms, 2 of them ad integrum. Eleven remained unchanged, without further progress and 2 patients worsened after surgery or despite it. Our results showed a direct correlation between the time-lag and the outcome of therapy. The average time span between recognition of disease and operation in those patients whose symptoms improved was about 16.7 months, whereas for those who remained unchanged it was 52.4. In the patients who worsened it was 54 months.
  
  
  CONCLUSIONS
  Virtually all patients operated within the first year showed a subsequent improvement of symptoms. Only 25 % of patients operated at a later stage achieved some measure of improvement. Time is a relevant factor for success.
authors.affiliation: Department of Paediatric Surgery, Comenius University, Bratislava, Slovak Republic.
authors.forename: L
authors.initials: L
authors.lastname: Hajnovic
authors.forename: J
authors.initials: J
authors.lastname: Trnka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004576:Electromyography; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D009436:Neural Tube Defects / Q000175:diagnosis / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome