SURGICAL MANAGEMENT OF TETHERED CORD SYNDROME IN CHILDREN AND ADOLESCENTS
Background: Tethered cord syndrome in adolescents and children present insidiously and is relatively rare as compared
to open spinal dysraphism. Surgical release and decompression of the spinal cord is the primary mode of management.
Methods: This is a prospective case series of 15 patients who were diagnosed as cases of tethered cord syndrome
due to occult spinal dysraphism. Presenting features, operative findings and postoperative course was recorded. The
study was conducted between January 2015 and July 2016 at the department of neurosurgery, Hayatabad Medical
Complex Peshawar. All patients under 18 years of age irrespective of their gender were included.
Results: Fifteen patients, admitted during the study period with 9 (60%) males and 6 (40%) females with a mean age
of 10.1 ± 5.1 years. Lower limbs pain was most common clinical presentation which occurred in 9 (66.6%) patients.
This followed by urinary symptoms (n = 7, 46.6%), such as urinary retention, voiding difficulties, urge incontinence
and frequent bed wetting. Backache was present in 1 (6.6%) patient, lower limb weakness was observed in 6 (40%)
patients.Physical examination revealed a swelling on the back in 12 (80%) patients, Faun’s tail was present in 5 (33.3%)
patients, skin dimpling was noted in 3 (20%) and kyphoscoliosis was present in 2 (13.3%). Postoperative complications
included cerebrospinal fluid (CSF) leak in 4 (26.6%) patients and infection of the wound in 2 (13.3%) patients. Only two
patients underwent reoperation for dural closure.
Conclusion: Tethered cord syndrome is a disorder with significant neurologic consequences for the younger age
patients. However, the clinical features are not very specific and maintenance of higher clinical suspicion is mandatory
to intervene timely and save the child from neurologic deterioration. Postoperatively, if dura is opened, CSF leak is the
major complication which may lead to longer hospital stay and higher morbidity.
Keywords: Spinal dysraphism, spina bifida occulta, tethered cord syndrome, management