title: Children with tethered cord syndrome of different etiology benefit from microsurgery-a single institution experience.
abstract: OBJECTIVE
  The term "tethered cord syndrome" (TCS) illustrates, according to the literature, both a separate diagnosis, as well as a combination of symptoms in the context of dysraphic conditions. The common denominator is the increased tension and abnormal stretching of the spinal cord, caused by tissue attachments that limit its movement in the spinal canal. In light of the fact that no real data exists regarding the management of these patients, the purpose of this single institutional study is to underscore management strategies and discuss the results, pitfalls, and the treatment of pediatric patients with tethered cord syndrome.
  
  
  RESULTS
  The clinical outcome in 20 pediatric patients was studied retrospectively. Ten children with closed spinal dysraphism, nine with tethering after postpartum myelomeningocele repair, and one child with an infected open dermal sinus were included. A total of 22 detethering procedures were performed. The most common symptoms prior to surgery were muscle weakness and urinary dysfunction, followed by foot deformities and pain. Of all symptoms, pain responded most favorably to surgical treatment. There was improvement in 11 out of 15 patients with preoperative motor deficits, while that was the case in 11 out of 16 patients with urinary dysfunction.
  
  
  CONCLUSIONS
  In view of the lack of evidence regarding the treatment of children with tethered cord syndrome, the best way to aim for a favorable outcome is correct indication for surgical intervention, combined with the implementation of technical advancements, such as intraoperative neurophysiological monitoring and ultrasound.
authors.affiliation: Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Stavrinou
authors.forename: Mathias
authors.initials: M
authors.lastname: Kunz
authors.forename: Markus
authors.initials: M
authors.lastname: Lehner
authors.forename: Alfred
authors.initials: A
authors.lastname: Heger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Müller-Felber
authors.forename: Joerg-Christian
authors.initials: JC
authors.lastname: Tonn
authors.forename: Aurelia
authors.initials: A
authors.lastname: Peraud
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery; D009436:Neural Tube Defects / Q000209:etiology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome