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Tethered Cord in Children with Spina Bifida

  • Robin M. Bowman
  • David G. McLone

Abstract

Any process that attaches and fixes the spinal cord, inhibiting movement of the cord in the spinal canal, has the potential to cause tethered cord syndrome. Motion of the head and trunk changes the length of the spinal canal and the cord must move cranially to accommodate increases in length. If the cord is unable to move, it must lengthen to accommodate increased distance. The epipial layer of the spinal cord contains abundant collagen and extension narrows the cord and causes this layer to squeeze the interior of the cord, elevating intramedullary pressure. This is much like the children’s toy, the “finger trap”. The harder you pull the tighter the squeeze. When intramedullary pressure exceeds perfusion pressure, the cord becomes ischemic and metabolism ceases. Repetitive or prolonged stretching of the spinal cord leads to infarction and a deficit. As would be expected, the deterioration is usually subtle, progressive, may be reversible and only rarely catastrophic. Hoffman, Hendrick, and Humphreys described this problem in children in 1976 [1]. Yamada demonstrated the physiology in the laboratory in 1981 [2].

Keywords

Spinal Cord Spinal Fusion Spina Bifida Tethered Cord Dural Closure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Hoffman HJ, Hendrick EB, Humphreys RP (1976) The tethered spinal cord. Its protean manifestations, diagnosis, and surgical correction. Childs Brain 2:145–155PubMedCrossRefGoogle Scholar
  2. 2.
    Yamada S, Won DJ, Yamada SM (2004) Pathophysiology of tethered cord syndrome: correlation with symptomatology. Neurosurg Focus 16(2):E6PubMedCrossRefGoogle Scholar
  3. 3.
    Bowman RM, Seibly JM, McLone DG (in press) Tethered cord release: A long-term study of 114 patientsGoogle Scholar
  4. 4.
    Bowman RM, McLone DG, Grant JA et al (2001) Spina bifida outcome: a 25-year prospective. Pediatric Neurosurgery 34:114–120PubMedCrossRefGoogle Scholar
  5. 5.
    Dias MS, McLone DG (1993) Hydrocephalus in the child with dysraphism. Neurosurg Clin N Am 4(4):715–726PubMedGoogle Scholar
  6. 6.
    Tomita T, McLone DG (1983) Acute respiratory arrest. Am J Dis Child 137:142–144PubMedGoogle Scholar
  7. 7.
    Phuong LK, Schoeberl KA, Raffel C (2002) Natural history of tethered cord in patients with meningomyelocele. Neurosurgery 50(5):989–993PubMedCrossRefGoogle Scholar
  8. 8.
    Rinaldi F, Cioffi FA, Columbano L et al (2005) Tethered cord syndrome. J Neurosurg Sci 49(4):131–135PubMedGoogle Scholar
  9. 9.
    Cochrane DD, Rassekh SR, Thiessen PN (1998) Functional deterioration following placode untethering in myelomeningocele. Pediatric Neurosurgery 28(2):57–62PubMedCrossRefGoogle Scholar
  10. 10.
    Schoenmakers MA, Gooskens RH, Gulmans VA et al (2003) Long-term outcome of neurosurgical untethering on neurosegmental motor and ambulation levels. Dev Med Child Neurol 45(8):551–555PubMedCrossRefGoogle Scholar
  11. 11.
    Blount JP, Tubbs RS, Okor M et al (2005) Supra-placode spinal cord transection in paraplegic patients with myelodysplasia and repetitive symptomatic tethered spinal cord. J Neurosurg 103(1 Suppl):36–39PubMedGoogle Scholar
  12. 12.
    Archibeck MJ, Smith JT, Carroll KL et al (1997) Surgical release of tethered spinal cord: survivorship analysis and orthopedic outcome. J Pediatr Orthop 17(6):773–776PubMedCrossRefGoogle Scholar
  13. 13.
    Abrahamsson K, Olsson I, Sillen U (2007) Urodynamic findings in children with myelomeningocele after untethering of the spinal cord. J Urol 177(1):331–334PubMedCrossRefGoogle Scholar
  14. 14.
    Herman JM, McLone DG, Storrs BB, Dauser RC (1993) Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered spinal cord. Pediatr Neurosurg 19:243–249PubMedCrossRefGoogle Scholar
  15. 15.
    Sarwark JF, Weber DT, Gabrieli AP et al (1996) Tethered cord syndrome in low motor level children with myelomeningocele. Pediatr Neurosurg 25(6):295–301PubMedCrossRefGoogle Scholar
  16. 16.
    McLone DG, Herman JM, Gabrieli AP, Dias L (1990–91) Tethered cord as a cause of scoliosis in children with a myelomeningocele. Pediatr Neurosurg 16:8–13PubMedCrossRefGoogle Scholar
  17. 17.
    Pierz K, Banta J, Thomson J et al (2000) The effect of tethered cord release on scoliosis in myelomeningocele. J Pediatr Orthop 20(3):362–365PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Robin M. Bowman
    • 1
  • David G. McLone
    • 2
    • 3
  1. 1.Department of Neurosurgery Children’s Memorial HospitalNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of Pediatric Neurosurgery Spina Bifida CenterChildren’s Memorial HospitalItalia
  3. 3.Department of Neurological SurgeryNorthwestern University Feinberg School of MedicineChicagoUSA

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