The effects of detethering on the urodynamics profile in children with a tethered cord. (original) (raw)

Abstract

ETHERING of the spinal cord is a pathological fixation of the cord in the spinal column. It can be caused by congenital defects involving neurulation processes, such as meningocele, lipomeningocele, split cord malformation, and dermal sinus tract, or the tail bud canalization processes, such as a thick terminal filum, filar lipoma, and terminal myelocystocele. 12 In 3 to 15% of patients who undergo surgical repair of spina bifida, tethering occurs as a result of postoperative scarring. 8,15,16 A tethered spinal cord can cause urinary tract deterioration, producing symptoms of urinary incontinence, impaired bladder compliance, and/ or detrusor hyperreflexia. It can also lead to other pathological conditions, such as back pain, gait deterioration, leg weakness, hip and knee contractures, scoliosis, sensory loss, changes in bowel function, and orthopedic foot deformities. Authors of previous studies have evaluated the effects of detethering on bladder function-although some have found improvement, others have not. Because urodynamic testing has proven to be useful in the assessment of urological impairment associated with a tethered cord (with sensitivity approaching 100% for diagnoses such as sphincter dyssynergia 18 ), we sought in this study to characterize the effects of early detethering on the postoperative urodynamic profile in children.

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  23. Manuscript received December 28, 2005. Accepted in final form August 7, 2006. Address reprint requests to: Victor Perry, M.D., Department of Neurological Surgery, University of California, San Francisco, Box 0112, 505 Parnassus Avenue, Moffitt M779, San Francisco, Cali- fornia 94143-0112. email: perryv@neurosurg.ucsf.edu.