title: Variation in Outcome in Tethered Cord Syndrome.
abstract: METHODS
  Fifty patients surgically treated for tethered cord syndrome (TCS) were retrospectively studied at Liaquat National Hospital, Karachi from 2010 until 2014.
  
  
  OBJECTIVE
  To assess the common presentations of TCS in our part of the world and the surgical outcome of the different presentations.
  
  
  BACKGROUND
  TCS is a stretch-induced functional disorder of the spinal cord with its caudal part anchored by an inelastic structure, which results in characteristic symptoms and signs. Due to the variety of lesions and clinical presentations and the absence of high-quality clinical outcome data, the decision regarding treatment is difficult.
  
  
  METHODS
  Fifty consecutive patients with TCS were reviewed retrospectively with a follow-up period of 12-48 months. The majority of the patients were 0-15 years of age with the mean age of 4 years. The presenting complaints and the associated pathologies were documented, and the patients were assessed using the new Karachi TCS severity scale for clinical assessment.
  
  
  RESULTS
  Eighty five percent of the patients with thickened filum terminale improved. Sixty six percent of the patients with diastematomyelia, 60% with lipoma and only 46% with myelomeningocele showed clinical improvement postoperatively. Sixty two percent of the patients who presented with paraperesis improved following surgery while 37% remained stable and only one patient deteriorated. Back and leg pain improved in 93% of patients and 50% of patients with urinary impairment improved.
  
  
  CONCLUSIONS
  Outcome of patients with TCS varies according to pathology and severity of symptoms. Diastematomyelia and thickened filum had the best outcome. The Karachi TCS severity scale is a valid tool for future studies.
authors: Department of Spinal and Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
authors: Noorulain
authors: N
authors: Iqbal
authors: Department of Spinal and Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
authors: Mohsin
authors: M
authors: Qadeer
authors: Department of Spinal and Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
authors: Salman Yousuf
authors: SY
authors: Sharif
keywords: Outcome; Spine; Tethered cord syndrome; Thickened filum; Untethering