Tethered cord syndrome in different types of spina bifida in children

BACKGROUND: Tethered cord syndrome (TCS) occurs in 10-75% of children after correction of myelomeningocele and lipomyelomeningocele. Early diagnosis and surgical treatment of TCS after correction of different types of spina bifida remains a challenging problem of modern neurosurgery. MATERIALS AND METHODS: Since January till December 2008 in Burdenko Neurosurgical Institute 15 children were prospectively examined and operated. All of them had TCS after surgical treatment of spina bifida: myelomeningocele--7 (47%), lipomyelomeningocele--4 (27%), meningoradiculocele--1 (7%), meningocele--2 (13%), diastematomyelia--1 (7%). In the analyzed series peak of TCS manifestation was within 4 and 12 years. RESULTS: Clinical presentation of the disease consisted of neurological, urological, proctological and orthopaedic syndromes. In the postoperative period positive results were observed in most cases: regression of pain syndrome in 7 cases (87.5%), increase of muscle strength--in 4 (57%), improvement of sensory function--in 2 (33.3%), full or partial improvement of bladder and rectal function--in 4 (33.3%) and 5 (41.7%), respectively. Surgical complications occurred in 7 patients (46%): would CSF leak in 3 (20%), pseudomeningocele in 1 (6.7%), transient urinary retention in 2 (13.3%), wound insufficiency due to CSF leak in 1 (6.7%), motor deterioration in 1 (6.7%). CONCLUSION: Early surgical treatment of TCS in most cases leads to stabilization or improvement of neurological status. Risk of surgical complications associated with CSF leak indicates that optimal ways of their prevention should be developed.