- Discussion:
- tethered cord syndrome is more frequent in children who have a myelomeningocele at level of L4 & L5 as opposed to those who have a
lesion at thoracic level;
- diff dx:
- hydromyelia:
- while both a syrinx and tethered cord can cause scoliosis a functioning ventriculoperitoneal shunt will tend to rule out hydromyelia
as a cause of an evolving scoliosis;
- Clinical Findings:
- most common in children between 1 & 2 years;
- increased lumbar lordosis;
- back & buttock pain
- spasticity in the sacral roots;
- scoliosis;
- may see rapid progression of scoliosis;
- tethered cord may cause scoliosis is above level of paralysis or above open defect of meningocele unlike a paralytic scoliosis;
- development of scoliosis at young age may indicate tethered cord;
- Radiology:
- MRI is effective in identifying hydromyelia & syringomyelia, but it is not as definitive in determining whether spinal cord is tethered;
- CT - myelography is more accurate in identifying area of tethering;
- Treatment:
- release may not result in improvement or resolution of scoliosis, but does arrest its progression and may facilitate non-op management;
- in the report by Pierz K, et al (2000), 21 patients with spinal dysraphism and scoliosis who had undergone a detethering procedure were
retrospectively reviewed;
- 3 patients had thoracic, 12 had lumbar, and six had sacral level myelomeningocele;
- 3 patients (14%) had curves that improved, and six (29%) stabilized.
- 12 patients (57%) progressed >10 degrees.
- 86 percent of patients with initial curves of >40 degrees and 100% of thoracic level patients went on to require spinal fusion;
- 8 complications occurred in six patients;
- although patients with curves <40 degrees may have some improvement after a detethering procedure, those presenting with curves
>40 degrees or thoracic neurologic levels had no improvement in their scoliosis.
- ref: The effect of tethered cord release on scoliosis in myelomeningocele.