Zur klinischen Problematik des Tethered-Cord-Syndroms - Bericht über drei eigene Beobachtungen

: Tethered cord syndrome is defined as a low state of the conus medullaris below the lumbar vertebra 2 after the neonatal period. Possible causes are: short thickened filum terminale, fibrotic ligaments, intradural lipomas. The clinical course is characterised by motoric and sensory deficits, disturbances of balance, neurogenic bladder disturbances, foot deformities and backache. A 3-year-old boy after operation of a lipomyelomeningocele at 2 months showed a one-sided leg shortening and a progressive neurogenic bladder and intestinal disturbance. The cause was a low state of the conus with a shortened filum terminale and a remainder of a lipoma. A 7-year-old boy after operation of a thoraco-lumbar meningomyelocele developed a progressive asymmetric paraspastic state with contractures. The neuro-radiological diagnosis of an intradural dermoid was verified on operation. A 10-year-old boy after operation of a covered lumbosacral meningocele showed a progressive backache which was connected with flexion. We found a low state of the conus through adhesions caused by scars which could be removed operatively. A collaborative treatment by the paediatric surgeon and the neuro-paediatrician of patients with dysraphic disturbances can prevent the severe consequences of the tethered cord problems with the co-operation and early intervention of the neuropaediatric surgeon.