Tethered Cord Release

Indications

• Tethered cord on magnetic resonance imaging (MRI) (myelomeningocele, lipomyelomeningocele [LMMC], myelocystocele, spinal cord adhesions, thickened fatty filum, dermal sinus tract, diastematomyelia, tumors, epidermoid/dermoid/neurenteric cysts) with progressive clinical symptoms such as pain, sensory impairment, weakness, spasticity, urinary/bowel dysfunction, foot deformity, and scoliosis that can be correlated with the spinal cord anomaly.

• Asymptomatic patients, with the type of tethered cord that has a high risk of deterioration and an acceptable risk of surgery (e.g., dermal sinus tract with cutaneous dimple, diastematomyelia).

• Asymptomatic patients with unpredictable risk of deterioration, with an acceptable risk of detethering (e.g., limited dorsal myeloschisis, transitional LMMC, myelocystocele).

• There is no clear evidence available to address the necessity or the optimal timing of prophylactic surgery in asymptomatic patients. In this situation, the complexity and risk of complications should be carefully considered.