Surgical Outcome of Adolescents and Young Children with Tethered Cord Syndrome: A Retrospective Analysis

  • Ayaz Ahmad Department of Neurosurgery, Hayatabad Medical Complex
  • Muhammad Ali Noman Department of Neurosurgery, Hayatabad Medical Complex
  • Muhammad Mukhtar North West General Hospital & Research Hospital Peshawar – Pakistan
  • Imran Khan North West General Hospital & Research Hospital Peshawar – Pakistan
  • Muhammad Mushtaq North West General Hospital & Research Hospital Peshawar – Pakistan
  • Shahid Ayub Department of Neurosurgery, Hayatabad Medical Complex
Keywords: Spinal Dysraphism, Spina bifida Occulta, Tethered Cord Syndrome


Objective:  In Spinal dysraphism, neural tube defect is one of the leading causes of congenital central nervous system disorders and contributes to a high proportion of disability and mortality. This study aimed to evaluate the outcome of the detethering of tethered cord syndrome.

Materials & Methods:  The study was conducted at the Neurosurgery Department of Hayatabad Medical Complex Peshawar. A total of 110 patients were included in our study. Clinical examination was recorded for back swelling, dermal stigmata, scars, lower limb neurological function, sensory deficits, reflexes. Also, look for any deformities like kyphoscoliosis or limb deformities and the presence/absence of neuropathic ulcers. Imaging studies were recorded for diagnosis, the level of spinal tethering, presence/absence of syrinx, and spine deformities. During the surgical operation, the diagnosis of the lesion was confirmed and the interventional procedure was recorded.

Results:  One hundred ten patients were admitted during the study period with 57 (52.2%) females and 53 (47.8%) males with a mean age of 9.3 years (SD ± 4.3). Most patients had presented with pain in lower limbs (60.9%) and backache was (34.8%). The most common operative complication was CSF leak in 29 patients (26.1%) while wound infection occurred in 14 (13%) cases.

Conclusion:  Tethered cord syndrome due to occult spinal dysraphism is a rare disease with significant neurologic consequences for the younger generation. Early clinical diagnosis and good surgical treatment could prevent the development of these complications.


1. Hoffman HJ, Hendrick EB, Humphreys RP. The tethered spinal cord: its protean manifestations, diagnosis, and surgical correction. Childs Brain, 1976; 2 (3): 145-55.
2. Das K, Shubha AM. The management of tethered cord syndrome complicating occult spinal dysraphism in children: Experience from a spina bifida clinic. JIMSA. 2014; 27 (2): 86-90.
3. Hendrick EB, Hoffman H, Humphreys RP. The tethered spinal cord. Clin Neurosurg. 1983; 30: 457-63.
4. Yi Y, Lindemann M, Colligs A, Snowball C. Economic burden of neural tube defects and impact of prevention with folic acid: a literature review. Eur J Pediatr. 2011; 170: 1391–1400.
5. Lo A, Polsek D, Sidhu S. Estimating the burden of neural tube defects in low- and middle-income countries. J Glob Health, 2014; 4 (1): 010402.
6. Mosley BS, Cleves MA, Siega-Riz AM, Shaw GM, Canfield MA, Waller DK, et al. Neural tube defects and maternal folate intake among pregnancies conceived after folic acid fortification in the United States. Am J Epidemiol. 2009; 169: 9–17.
7. Sarris CE, Tomei KL, Carmel PW, Gandhi CD. Lipomyelomeningocele: pathology, treatment, and outcomes. A review. Neurosurg Focus. Oct. 2012; 33 (4): E3.
8. Mishra SS, Panigrahi S, Dhir MK, Parida DK. Tethered cord syndrome in adolescents: Report of two cases and review of literature. J
Pediatr Neurosci. 2013; 8 (1): 55-8.
9. Jeelani Nu O, Jaspan T, Punt JAG. Tethered cord syndrome after myelomeningocele Repair, 1999; 318: 516-17.
10. Samuels R, McGirt MJ, Attenello FJ, Ambrossi GLG, Singh Neil, Solakoglu Can, et al. Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty. Childs Nerv Syst. 2009; 25: 1085-89.
11. Muthukumar N. Congenital spinal lipomatous malformations: part I – Classification. Acta Neurochir (Wien), 2009; 151 (3): 179-88:197.
12. Muthukumar N. Congenital spinal lipomatous malformations: part II – Clinical presentation, operative findings, and outcome. Acta Neurochir (Wien), 2009 Mar; 151 (3): 189-97; Discussion 197.
13. Golalipour MJ, Qorbani M, Mirfazeli A, Mobasheri E. Risk factors of neural tube defects in Northern Iran. Iran Red Crescent Med J. 2014; 16 (6): e7940.
14. Grewal J, Carmichael SL, Song J, Shaw GM. Neural tube defects: An analysis of neighbourhood- and individual-level socio-economic characteristics. Paediatr Perinat Epidemiol. 2009; 23 (2): 116-24.
15. Au KS, Koch AA, Northrup H. Epidemiologic and genetic aspects of spina bifida and other neural tube defects. Dev Disabil Res Rev. 2010; 16 (1): 5-15.
16. Solmaz I, Izci Y, Albayrak B, Centinalp E, Kural C, Sengul G, et al. Tethered cord syndrome in childhood: Special emphasis on the surgical technique and review of the literature with our experience. Turk Neurosurg. 2011; 21 (4): 516-21.
17. Koo IK, Kim SH, Bae JH, Kim OL, Choi BY, Cho SH. Tethered cord syndrome in adulthood. J Korean Neurosurg Soc. 1997; 26: 830-35.
18. Phi JH, Lee DY, Jahng TA, Chung CK, Kim HJ. Tethered cord syndrome in adulthood: Reconsidering the prognosis. J Korean Neurosurg. Soc. 2004; 36: 114-19.
19. Iskandar BJ, Fulmer BB, Hadley MN, Oakes WJ. Congenital tethered spinal cord syndrome in adults. Neurosurg Focus, 2001; 10 (1): e7.
20. Kang JK, Yoon KJ, Ha SS, Lee IW, Jeun SS, Kang SG. Surgical management and outcome of tethered cord syndrome in school-aged children, adolescents and young adults. J Korean Neurosurg Soc. 2009; 46: 468-71.
21. Kang JK, Lee KS, Jeun SS, Kang SG, Yoon KJ, Ha SS. Tethered cord syndrome; Surgical indication, technique and outcome. J Korean Neurosurg Soc. 2007; 42: 77-82.
22. Galhom AE, Deeb WA, Osama A. Early clinical characteristics and surgical outcome in 10 children with occult spinal dysraphism. Egypt J Neurol Psychiat Neurosurg. 2013; 50 (2): 127-34.
23. Erfani MA, Ganjavian MS, Ameri E, Namazi H, Solooki S. Occult intraspinal abnormalities and congenital scoliosis. JRMS. 2007; 12 (2): 53-57.
24. Gharedaghi M, Samini F, Mashhadinejad H, Khanjavi M, Samini M. Orthopedic lesions in tethered cord syndrome: The importance of early diagnosis and treatment on patient outcome. Arch Bone Joint Surg. 2014; 2 (2): 93-97.
25. Shweikeh F, Al-Khouja L, Nuño M, Johnson JP, Drazin D, Adamo MA. Disparities in clinical and economic outcomes in children and adolescents following surgery for tethered cord syndrome in the United States. J Neurosurg Pediatr. 2015: 1-7.
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