2025 Peds Day Presentations
Year: 2026
Type: article
Abstract: Tethered spinal cord is a phenomenon in which abnormal attachments of the spinal cord lead to spinal cord stretch and tension.Tethered cord syndrome represents the constellation of clinical manifestations that result from abnormal cord tension, including symptoms of back pain, leg pain, lower extremity weakness or sensory disturbance, neurogenic bladder, mobility changes, as well as foot and spinal deformity.Common disorders that can lead to a tethered spinal cord include varying forms of spina bifida, such as myelomeningocele, lipomyelomeningocele, and fatty filum, as well as other disorders including dermal sinus tracts, limited dorsal myeloschisis, VACTERL, caudal regression, split cord malformation, OEIS complex, and post-intradural tumor resection.The traditional treatment of tethered spinal cord is with direct microsurgical untethering surgery, often involving a dorsal approach to the spine for laminectomy(s), followed by intradural exploration and direct cord untethering.This surgery often involves the use of an operating microscope and is done by experienced pediatric and/or adult neurosurgeons.To improve the safety of the intervention, intraoperative neurophysiological monitoring (IONM), which can be used to measure motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), and free-running and triggered electromyography (EMG), is often employed.The risks of the traditional surgical approach include cerebrospinal fluid (CSF) leak, neurological injury that is often temporary but occasionally permanent, wound complications, and the risk of recurrent tethered cord due to scar tissue recurrence around the cord.The surgical challenge of adhesiolysis of abnormal attachments to neural elements, and thereby, the risk of complications tends to increase with repeat untethering procedures. 1 Inflammation within the CSF space can also contribute to arachnoiditis, in which the investing arachnoid layer around the cord and nerves becomes thick and tough.The treatment for this is quite challenging.Because tethered cord recurrence after the initial surgery is not uncommon, some surgeons have offered an alternative procedure: spinal column shortening.This typically involves a posterior approach to the spine for near-complete vertebrectomy (often at the T12 level to avoid iatrogenic malalignment of the spine) along with short-segment thoracolumbar fusion to stabilize the spine across the three-column osteotomy site.The elegance of this approach is that the intradural space is not entered; instead, screws and rods are used to close the three-column osteotomy defect and 'shorten' the spine.This improves spinal cord laxity, pulsatility, and vascularity, which can meaningfully improve tethered cord symptoms.Although this surgery is newer, results are promising, especially with respect to back and leg pain improvement.2,3 Spinal column shortening is most commonly reserved for patients who have previously undergone untethering procedures and have reached skeletal maturity.Special consideration should be given to patients with other spinal deformities such as scoliosis and kyphosis, because appropriate fusion level selection can be affected by these conditions.Although the results so far are promising, long-term outcomes and the durability of spinal column shortening are less well understood, and appropriate counseling with the patient/family is imperative.
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225110043