Abstract

Introduction
Tethered spinal cord syndrome is a constellation of neurologic, orthopedic,
urologic, and pain symptoms. A cord can be tethered by some dorsal or caudal
tethering element, including spinal dysraphisms, myelomeningoceles,
lipomyelomeningoceles, and even simple fatty filums. The management of an
asymptomatic tethered cord is controversial, with advocates for both conservative
management and surgical release. At our institute, the management of an
asymptomatic tethered cord is evolving to best match what the data suggests to be
the most beneficial outcome, and thereby the goal of this study is to work towards
finding the merits of these two methods for use in a clinical setting.
Methods and Materials
Clinical and surgical data collected over the last eighteen years from our
institute at the Stollery Children's Hospital was analyzed. A total of 84 patients were
included, all with a fatty filum as a cause of a tethered cord, varying in age of
presentation from birth to sixteen years old. These patients were divided into
categories based on clinical presentation and medical/surgical course of action that
was taken in treatment of these individuals: patients that were conservatively
managed, patients that were given a prophylactic release, and symptomatic cases
which were surgically managed. The majority of patient data was gathered from
surgical records, and therefore there are an exaggerated percentage of surgical
cases compared to nonsurgical cases.
Results
There were eight conservatively managed patients with MRI confirmed fatty
filum, from which four patients did not require any surgical intervention and
remained asymptomatic while four patients did later develop symptoms related to
their tethered cord and required a surgical release. All four surgical procedures
showed resolution of symptoms. There were nineteen prophylactic releases, of
which only one required a secondary release procedure due to a cord retether.
Besides the case of retethering, there were five cases of transient symptoms
postoperatively and one case of surgical complication. Of the fifty-seven patients
who were surgically managed because of symptom presentation, eleven needed at
least one additional release of their tethered cord. Symptom resolution from surgery
varied based on the symptom. Urological symptoms (40) were improved in twentyfive cases (63%). Orthopedic symptoms (23) were improved in fourteen cases
(61%). Pain symptoms (20) were improved in fifteen cases (75%). Weakness
symptoms (23) were improved in fifteen cases (65%). Bowel symptoms (12) were
improved in five cases (42%). Some improvements required additional release
procedures to occur. It is important to recognize that many cases of tethered cord
are comorbid with other disorders, and therefore the symptom interactions from a

tethered cord release may not be as favourable as anticipated. Another important

factor is age of presentation. Many cases of symptomatic tethered cord present at a
very young age, with symptoms seen from birth and no asymptomatic period
whatsoever.

Conclusions
Though the data collected at our institution makes it difficult to amass a large
number of conservatively managed patients, the results of this study do suggest
there is merit in the conservative management of an asymptomatic tethered cord.
Although conservative management does not exclude the possibility of symptoms
developing from a tethered cord, symptoms can be managed effectively with
surgery at the point of their clinical presentation. It is difficult to either prove or
disprove the effectiveness of prophylactic release as opposed to conservative
management, but this data does show that conservative management can be used
effectively in the treatment of an asymptomatic tethered cord.