TETHERED CORD SYNDROME OF DELAYED ONSET FOLLOWING REPAIR OF MYELOMENINGOCELE
Hamdi Nabawi Mostafa1, Ahmed El-Sherif2, Mohammed Barania2, Mohammed Keshk2
Departments of Neurosurgery, 1Misr University for Science and Technology, 2Al-Azhar Faculty of Medicine, Egypt
Objective: Symptom response to spinal cord untethering is poorly understood in retethering after myelomeningocele (MMC) repair. In this study, children who developed spinal cord tethering following myelomeningocele repair were included to determine the impact of untethering on symptoms. Methods: A review of 14 children with symptomatic spinal cord tethering following MMC repair was performed. The response of symptoms to re-untethering was explored. Results: In this study, 14 patients who underwent surgery were diagnosed preoperatively with secondary spinal cord re-tethering syndrome after repair of MMC. There were nine males and five females. The presenting symptoms were lower limb pain, paraparesis, spasticity, kyphosis, and deterioration of sphincteric control. A tense cord in the MRI is a suggested sign of retethering. Postoperatively, all symptoms were either stable or improved in all patients. The postoperative course of all cases was uneventful. There were no significant complications except CSF leakage that was temporarily seen in 3 cases which stopped after secondary suture. Conclusions: Accurate diagnosis is the main predictor of the outcome of re-untethering. A tense cord in the MRI may be valuable in diagnosing the retethering Re-untethering procedure is feasible with a favorable outcome and low rate of complications.
June 2019