CLINICAL CORRELATES AND SURGICAL MANAGEMENT OF OCCULT SPINAL DYSRAPHISM WITH TETHERED CORD SYNDROME: EXPERIENCE FROM A TERTIARY CARE NEUROSURGERY DEPARTMENT
Background: Open spinal dysraphism is one of the leading cause of congenital central nervous system disorders
and contributes to a high proportion of disability and mortality in the younger generations. Occult spinal dysraphism is
relatively rare and usually presents clinically once the neurologic sequelae has settled in. The disorder most commonly
affects the adolescents and younger children and the most effective treatment is by surgical untethering of the spinal cord.
Methods: The study was conducted from January 2013 to December 2014 at the Neurosurgery Department of Hayatabad
Medical Complex Peshawar in a prospective manner involving all patients less than 18 years of age. Clinical
characteristics of patients with occult spinal dysraphism presenting with diagnosis of tethered cord syndrome were
recorded, surgical management planned and executed and the early postoperative course was followed.
Results: Twenty three patients were admitted during the study period with 12 (52.2%) females and 11 (47.8%) males
with a mean age of 9.3 years (SD ± 4.3). The most common presenting complaint was pain in lower limbs (60.9%)
and back (34.8%); followed by urinary symptoms (30.4%), lower limb weakness (26.1%) & claudication (26.1%) in that
order. The clinical findings included back swelling (65.2%), faun’s hairy tail (30.4%), feet ulcers (21.7%), skin dimpling
(13%) and kyphoscoliosis (8.7%). Lipomyelomeningocele (34.8%) was the commonest diagnosis, followed by meningocele
& diplomyelia (21.7%), dermal sinus & tethering after myelomeningocele repair (8.7%) and one case (4.3%)
of filum terminale thickening. The most common operative complication was CSF leak (26.1%) while wound infection
occurred in 3 (13%) cases.
Conclusion: Tethered cord syndrome due to occult spinal dysraphism is a rare disease with significant neurologic
consequences for the younger generation. Clinical vigilance and good operative treatment could prevent the development
of these complications. Further studies are required in order to better delineate the clinical characteristics of t