Surgical outcome of pediatric patients with symptomatic tethered cord syndrome at a tertiary care hospital
Abstract
Introduction: Patients with tethered cord syndrome become symptomatic during the period of their growth spurt. Apart from progressive foot and spinal deformities, patients also develop motor deficits and bladder and bowel dysfunction. Early diagnosis and adequate release of the tethered cord are indispensable to successful management.
Objectives: To study the trends in the neurological outcome after surgical treatment of cord tethering in pediatric population.
Methodology: Study was carried out from January 2018 to December 2019 at neurosurgery department, Fauji Foundation Hospital Rawalpindi. Thirty-five patients were included in the study who fulfilled the inclusion criteria.
Results: The average age of the patients at the time of the intervention was 11 years. There were 21 females (60.0%) and 14 males (40.0%). The distribution of neurological status improvement tells improvement in back pain in 28 patients (80%), improvement in motor function in 14 patients (40%), and improvement in urinary incontinence in 7 patients (20%).
Conclusion: This study concludes that back ache improves significantly after surgery while urinary incontinence is the least benefited symptom. Untethering along with the rehabilitation also helps majority of the patients with motor deficit. The ratio of symptomatic relief was best for backache and motor function and then improvement in the urinary control.
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References
Khan MA, Ahmad M, Sajjad F, Ali S. Out Come of Surgical Management of Tethered Cord Syndrome. Pak J Neurol Surg. 2015; 19(4):276-80.
Seki T, Hida K, Yano S, Houkin K. Surgical Outcomes of Pediatric Patients with Asymptomatic Tethered Cord Syndrome. Asian Spine J. 2018; 12(3):551.
DOI: https://doi.org/10.4184/asj.2018.12.3.551
Tuite GF, Thompson DN, Austin PF, Bauer SB. Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children's continence society. Neurourol. Urodyn. 2018; 37(3):890-903.
DOI: https://doi.org/10.1002/nau.23382
Roy RR, Haque SM, Al Mamun A, Rahman M. Tethered Cord Syndrome Causing Chronic Kidney Disease in a Child: A rare event Case Reports. J Pediatr. Nephrol . 2017; 5(2).
Steinbok P, MacNeily AE, Hengel AR, Afshar K, Landgraf JM, Hader W, et al. Filum section for urinary incontinence in children with occult tethered cord syndrome: a randomized, controlled pilot study. J Urol. 2016; 195(4):1183-8.
DOI: https://doi.org/10.1016/j.juro.2015.09.082
Sofuoglu OE, Abdallah A, Emel E, Ofluoglu AE, Gunes M, Guler B. Management of tethered cord syndrome in adults: experience of 23 cases. Turk Neurosurg. 2017; 27(2):226-36.
DOI: https://doi.org/10.5137/1019-5149.jtn.15892-15.1
Starnoni D, Duff JM, Chittur Viswanathan G. Duplicated filum terminale in non-split cord malformations: An underrecognized cause for treatment failure in tethered cord syndrome. J Spinal Cord Med. 2017; 40(4):481-4.
DOI: https://doi.org/10.1080/10790268.2016.1227896
Abdallah A, Emel E, Abdallah BG, Asiltürk M, Sofuoğlu ÖE. Factors affecting the surgical outcomes of tethered cord syndrome in adults: a retrospective study. Neur Review. 2018; 41(1):229-39..
DOI: https://doi.org/10.1007/s10143-017-0842-z
Garg K, Tandon V, Kumar R, Sharma BS, Mahapatra AK. Management of adult tethered cord syndrome: our experience and review of literature. Neurol India. 2014; 62(2):137.
DOI: https://doi.org/10.4103/0028-3886.132329
Hou Y, Sun J, Shi J, Guo Y, Wang Y, Shi G, et al. Clinical evaluation of an innovative operative procedure in the treatment of the tethered cord syndrome. Spine J 2018; 18(6):998-1004.
DOI: https://doi.org/10.1016/j.spinee.2017.10.009
Thuy M, Chaseling R, Fowler A. Spinal cord detethering procedures in children: a 5 year retrospective cohort study of the early post-operative course. J Clin Neurosci. 2015; 22(5):838-42.
DOI: https://doi.org/10.1016/j.jocn.2014.11.019
Seki T, Hida K, Yano S, Sasamori T, Hamauch S, Koyanagi I, et al. Surgical outcome of children and adolescents with tethered cord syndrome. Asian Spine J. 2016; 10(5):940-4.
DOI: https://doi.org/10.4184/asj.2016.10.5.940
Broderick KM, Munoz O, Herndon CA, Joseph DB, Kitchens DM. Utility of urodynamics in the management of asymptomatic tethered cord in children. World J Urol. 2015 1;33(8):1139-42.
DOI: https://doi.org/10.1007/s00345-014-1414-2
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; 15(4):427-33.
DOI: https://doi.org/10.3171/2014.9.PEDS14241
Shukla M, Sardhara J, Sahu RN, Sharma P, Behari S, Jaiswal AK, Srivastava AK, Mehrotra A, Das KK, Bhaisora KS. Adult versus pediatric tethered cord syndrome: Clinicoradiological differences and its management. Asian J Neurosurg. 2018; 13(2):264.
DOI: https://doi.org/10.4103/1793-5482.228566
Glenn C, Cheema AA, Safavi–Abbasi S, Gross NL, Martin MD, Mapstone TB. Spinal cord detethering in children with tethered cord syndrome and Chiari type 1 malformations. J. Clin Neurosci. 2015; 22(11):1749-52.
DOI: https://doi.org/10.1016/j.jocn.2015.05.023
Behaine J, Latif AM, Greenfield JP. Fecal incontinence as a predominant symptom in a case of multiply recurrent tethered cord: diagnosis and operative strategies. J Neurosurg Pediatr. 2015; 16(6):748-51.
DOI: https://doi.org/10.3171/2015.5.PEDS15124
Ur Rehman Z, Khan MM, Ayub S. Surgical management of tethered cord syndrome in children and adolescents. Khyber J Med Sci 2017; 10(1):58.
Iqbal N, Qadeer M, Sharif SY. Variation in Outcome in Tethered Cord Syndrome. Asian Spine J 2016; 10(4):711-8.
DOI: https://doi.org/10.4184/asj.2016.10.4.711
DOInchez T, John RM. Early identification of tethered cord syndrome: a clinical challenge. J Pediatr Health Care. 2014; 28(3):e23-33.
DOI: https://doi.org/10.1016/j.pedhc.2013.06.007
Yasar S, Dogan A, Kayhan S, Kirmizigoz S, Kaplan A, et al. Surgery for tethered cord syndrome: when and how?. J Turgut Ozal Med Cent. 2018; 25(3):0503-10.
DOI: https://doi.org/10.5455/annalsmedres.2018.06.124
Lee JY, Kim KH, Park K, Wang KC. Retethering : A Neurosurgical Viewpoint. J Korean Neurosurg Soc. 2020; 63(3):346-357.
DOI: https://doi.org/10.3340/jkns.2020.0039
Shah M, Nouman MA, Khan MM, Nabi A, Tariq M, Ahmed A.Clinical correlates and surgical management of occult spinal dysraphism with tethered cord syndrome. Khyber J Med Sci. 2015; 8(1).
Granada C, Loveless M, Justice T, Moriarty T, Mutchnick I, Dietrich JE, et al, Hertweck P. Tethered Cord Syndrome in the Pediatric-Adolescent Gynecologic Patient. J Pediatr Adolesc Gy. 2015; 28(5):309-12.
DOI: https://doi.org/10.1016/j.jpag.2014.09.005
Jalai CM, Wang C, Marascalchi BJ, Horn SR, Poorman GW, Bono OJ, et al. Trends in the presentation, surgical treatment, and outcomes of tethered cord syndrome: A nationwide study from 2001 to 2010. J Clin Neurosci. 2017; 41:92-7
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