De-tethering of MRI demonstrated tethered cord

Recognition of tethered cord syndrome (TCS) in children is important because as the child grows, the spinal cord is stretched; and for patients with TCS, this leads to ischemia and subsequent neurological deficits, including bowel or bladder dysfunction, back pain, or lower extremity weakness. Radiologically, the presence of a fatty filum, thickened filum, or conus medullaris located caudal to L2 is considered a marker for tethering. The objective of this study is to ascertain how symptomatic tethering is defined in our institution and assess the rationale for surgical detethering in asymptomatic patients. Charts for patients who underwent detethering surgery between 4/1/2015 and 3/31/2019 at our institution were examined. Univariate logistic regression analyses were used to determine whether demographic and diagnostic factors predicted symptoms at presentation with TCS. There were 289 patients included. The modal patient was < 5 years of age, male, had a fatty filum and thickened filum, and did not have a low-lying conus. Patients < 5 years of age were less likely to have urological, gastrointestinal, and neurological or orthopedic symptoms; males were less likely to have urological symptoms; those with fatty fila were more likely to have gastrointestinal and neurological or orthopedic symptoms; patients with thickened fila were less likely to have urological symptoms; patients with low lying coni were less likely to have urological and gastrointestinal symptoms. Timely diagnosis and treatment of patients experiencing signs and symptoms related to tethering offers the possibility of resolution of deficits related to tethering, or at least prevents their progression.