title: The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome.
abstract: OBJECTIVE
  After primary repair of a myelomeningocele or a lipomyelomeningocele, patients can present with symptoms of secondary tethered cord syndrome (TCS). After surgical untethering, a small percentage of these patients can present with multiple repeat TCS. In patients presenting with secondary or multiple repeat TCS, the role as well the expected outcomes of surgical untethering are not well defined.
  
  
  METHODS
  Eighty-four patients who underwent spinal cord untethering after at least 1 primary repair were retrospectively evaluated using scaled and subjective outcome measures at short-term and long-term follow-up visits. Outcomes were analyzed for predictive measures using multivariate logistic regression.
  
  
  RESULTS
  Surgical untethering was performed in 66 patients with myelomeningoceles and 18 patients with lipomyelomeningoceles. Fourteen patients underwent multiple repeat spinal cord untethering. Patients were followed up for an average of 6.2 years. Most patients had stability of function postoperatively. Motor function and weakness improved in 7 and 16% of patients at 6 months, respectively, and 6 and 19% of patients at long-term follow-up evaluation, respectively. Of the patients who presented with back pain, 75% had improvement in symptoms at 6 months postoperatively. Younger age at untethering was significantly associated with worse long-term neurological outcomes. The number of previous untethering procedures, original diagnosis, sex, anatomical level, and degree of untethering had no effect on surgical outcomes.
  
  
  CONCLUSIONS
  Patients presenting with secondary or multiple repeat TCS may benefit from surgical untethering.
authors: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors: Wajd N
authors: WN
authors: Al-Holou
authors: Karin M
authors: KM
authors: Muraszko
authors: Hugh J
authors: HJ
authors: Garton
authors: Steven R
authors: SR
authors: Buchman
authors: Cormac O
authors: CO
authors: Maher
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001416:Back Pain; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008591:Meningomyelocele / Q000601:surgery; D009043:Motor Activity; D009436:Neural Tube Defects / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome