title: Inappropriate surgical interventions for midline fusion defects cause secondary tethered cord symptoms: implications for natural history report of four cases.
abstract: BACKGROUND
  The causes of tethered spinal cord are various. In order to release the tethering effect of these malformations, the surgical interventions must include removal of all tethering components, reconstruction of the neural tube and sectioning of tight filum terminale as well.
  
  
  METHODS
  The cases reported in this paper have had an operation many years before for various developmental defects. After a certain period of time (5-10 years) of the first operation, the patients reapplied to the hospital with various symptoms of spinal cord tethering, either vertical or horizontal.
  
  
  CONCLUSIONS
  At surgical intervention, it was noted that inappropriate surgical procedures caused retethering of the spinal cord in all patients. Postoperative period of all patients were uneventful. All patients declared relief in their symptoms. We would like to draw attention that untreated (or inappropriately treated) midline developmental defects will invariably cause syndrome of tethered cord. Consequently, prophylactic surgical untethering must be applied to all patients with developmental midline defects as soon as possible.
  
  
  CONCLUSIONS
  It looks that tethered cord symptoms invariably appear as enough negative influence accumulates as the time passes. Elapsed time may vary but unpleasant end result invariably arrives. While these cases with tethered spinal cord develop progressive neurological symptoms, prophylactic and appropriate surgical intervention should be considered as early as possible. There is no acceptable rationale to wait for the appearance of tethered cord syndrome symptoms to perform surgical untethering of the spinal cord because of the probability of irreversibility of the symptoms (incontinence of urine in particular) of tethered spinal cord syndrome.
authors.affiliation: Neurosurgery Department, Celal Bayar University, Medical School, 1403 sk 5/8 Alsancak, 35220, Izmir, Turkey. mselcuki@yahoo.com
authors.forename: Mehmet
authors.initials: M
authors.lastname: Selçuki
authors.forename: Ahmet Sükrü
authors.initials: AS
authors.lastname: Umur
authors.forename: Yusuf Kurtulus
authors.initials: YK
authors.lastname: Duransoy
authors.forename: Seymen
authors.initials: S
authors.lastname: Ozdemir
authors.forename: Deniz
authors.initials: D
authors.lastname: Selcuki
mesh_terms: D000328:Adult; D002420:Cauda Equina / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology; D009436:Neural Tube Defects / Q000150:complications* / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology*; D014555:Urination Disorders / Q000209:etiology