Urological Deterioration in Secondary Tethered Cord Syndrome and Clue to Detect It
Condition: Neurogenic Bladder; Tethered Spinal Cord Syndrome
MeSH terms: Urinary Bladder, Neurogenic; Neural Tube Defects; Spinal Cord Injuries; Syndrome
Study type: Observational

Summary: 
      Secondary tethered cord syndrome (STCS) has been diagnosed with signs of progressive
      deterioration in urological or neuroorthopedic systems following primary tethering surgery.
      However, there is no convincing urological diagnostic clue for STCS.
    

Detailed description: 
      Tethered cord syndrome (TCS) refers to various problems involving neurologic, orthopedic, and
      urologic systems, seen as a result of chronic traction of the spinal cord in patients with
      spinal dysraphism. Evidence for neural injury is often assumed irreversible, so untethering
      is justified to maintain neural function and prevent further neural damage. Unfortunately,
      some patients experienced an aggravation of symptoms following untethering. The probable
      causes are assumed to be the neural injury before or during operation, which was revealed
      along with dysplastic neural function, neural compression by increasing syrinx and secondary
      tethered cord syndrome (STCS) in which postoperative neural adhesion or syrinx limit motion
      of spinal and elicit ischemic changes as the spine grows during puberty. The Secondary
      Tethered Cord Syndrome is reported as 19% of cases and causes significant progressive
      morbidities in those who affected.

      Unfortunately, the detection of STCS is not as simple as it thought. Although magnetic
      resonance imaging (MRI) often reveals that the cord seems to get straightened, this does not
      necessarily mean that is a significant tethering or cord associated with progressive nerve
      damage. The variable course of progression and involvement of multiple systems such as lower
      extremity, bladder, bowel, and back would not allow a single specialist to draw conclusions
      about the presence of secondary tethered cord syndrome. Moreover, the untethering procedure
      of STCS may not always be safe and effective. Given the fact that a significant number of 'no
      improvement' or new onset complications following redo-untethering, the surgery could not be
      attempted without clear evidence. This explains the reason there is only a limited number of
      relevant studies so far.

      In this study, it aims to delinate the genuine features of secondary tethered cord syndrome
      by selecting and analyzing only cases with symptom improvements. Furthermore, it described
      their natural history and time course of urological deterioration and characterized by the
      urodynamic changes before and after the redo-untethering.
    

Intervention name(s): Redo-tethering operation
Intervention type(s): Procedure
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Children with signs of progressive deterioration in urological or neuroorthopedic system,
        and suspected Secondary Tethered Cord Syndrome (STCS) following primary untethering
        surgery.