title: Surgical Outcome of Children and Adolescents with Tethered Cord Syndrome.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To compare long-term results of surgery with the outcomes of symptomatic and asymptomatic tethered cord syndrome (TCS) in children and adolescents and to assess the surgery duration for those with TCS.
  
  
  BACKGROUND
  Pediatric patients with TCS continue to pose significant diagnostic and management challenges.
  
  
  METHODS
  We retrospectively analyzed the outcomes of 31 patients (16 males, 15 females) with TCS, including 21 with lumbosacral lipoma. All were surgically treated between 1989 and 2015. They were divided into symptomatic and asymptomatic TCS groups. The results of the treatment were summarized and analyzed using a non-parametric Mann-Whitney U test.
  
  
  RESULTS
  Nineteen patients had symptomatic TCS and 12 had asymptomatic TCS. Patients had a median age of 34 months (range, 0-201 months). The median follow-up period was 116 months (range, 7-223 months). Of the 19 symptomatic TCS patients, preoperative deficits improved after surgery in two (10.5%) and remained stable in 17 (89.5%) patients. One of the 12 asymptomatic TCS (8.3%) patients showed an exacerbated illness after surgery, and one in 11 patients remained stable (11.7%). There were significant differences in monthly age at surgery, preoperative bowel and bladder dysfunction, neurological function, presence/absence of clean intermittent catheterization introduction, and presence/absence of motor disorder at final follow-up (allp<0.05). In the univariate analysis, the presence/absence of preoperative bowel and bladder dysfunction, and symptoms were strongly associated with the risk of children and adolescents with TCS (p<0.05).
  
  
  CONCLUSIONS
  Early accurate diagnosis and adequate surgical release might lead to successful outcomes in children and adolescents with TCS. Surgical untethering is a safe and effective method for treatment of children with TCS.
authors: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Toshitaka
authors: T
authors: Seki
authors: Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan.
authors: Kazutoshi
authors: K
authors: Hida
authors: Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan.
authors: Shunsuke
authors: S
authors: Yano
authors: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Toru
authors: T
authors: Sasamori
authors: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Shuji
authors: S
authors: Hamauch
authors: Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.
authors: Izumi
authors: I
authors: Koyanagi
authors: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Kiyohiro
authors: K
authors: Houkin
keywords: Children; Lipoma; Lumbosacral; Outcome; Spina bifida