title: Surgical indication and outcome in patients with postoperative retethered cord syndrome.
abstract: OBJECTIVE
  After untethering of spinal dysraphism, some patients present with neurological deterioration, defined as retethered cord syndrome. It is known that surgical untethering is an option for improving the symptoms of retethered cord syndrome. Previous reports have shown that postoperative improvement in retethered cord syndrome was noted in the majority of patients presenting with pain, and in more patients with motor weakness than in those with urological symptoms. The authors speculate that subjective symptoms may be detected while symptoms are still reversible. In contrast, changes in urological function are less easy to diagnose, and delays in treatment may be complicated by advanced symptoms. In this study, patients with retethered cord syndrome were evaluated to investigate the benefits of performing routine urodynamic study to detect detrusor overactivity, which is considered to be a subclinical change of urological function, and to investigate the efficacy of early untethering surgery on the symptoms of retethered cord syndrome.
  
  
  METHODS
  Surgical indications and outcomes of 78 untethering operations (20 for myelomeningocele, 58 for spinal lipoma) for retethered cord syndrome were examined. Diagnosis of retethered cord syndrome was defined by a multidisciplinary spina bifida team, and included routine urodynamic study.
  
  
  RESULTS
  Preoperative symptoms included urological symptoms (70%), lower-extremity symptoms (45%), and others. The most frequent urological symptom was detrusor overactivity detected by urodynamic study (88.7%). Urinary incontinence was only found in 9.4% of patients. Postoperatively, progressive motor weakness improved in all patients, and sensory symptoms improved in 94%. Urological symptoms improved in 80% of the patients with urinary incontinence and in 75% of the patients with detrusor overactivity. Postoperative urodynamic study showed a significant increase in bladder volume (p < 0.05). The most common complication was temporary lower leg paresthesia that recovered at follow-up. Aggravated dysuria was noted in 3 patients.
  
  
  CONCLUSIONS
  Early untethering operations offer symptomatic relief to patients with retethered cord syndrome. Urodynamic study findings, especially detrusor overactivity, are considered to be the most significant indicators for early diagnosis of retethered cord syndrome.
authors.affiliation: Departments of Neurosurgery, Miyagi Children’s Hospital, Sendai, Japan. hayashi@nsg.med.tohoku.ac.jp
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hayashi
authors.forename: Jun
authors.initials: J
authors.lastname: Takemoto
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Ochiai
authors.forename: Tomomi
authors.initials: T
authors.lastname: Kimiwada
authors.forename: Reizo
authors.initials: R
authors.lastname: Shirane
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Sakai
authors.forename: Haruo
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D053159:Dysuria / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D007564:Japan; D007866:Leg / Q000503:physiopathology; D008067:Lipoma / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008499:Medical Records; D008591:Meningomyelocele / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology*; D009436:Neural Tube Defects / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010292:Paresthesia / Q000209:etiology; D010348:Patient Care Team; D012086:Reoperation; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000209:etiology*; D014549:Urinary Incontinence / Q000209:etiology*; D014563:Urodynamics