Background/Aim: Sectioning of the filum terminale is performed when spinal cord tethering is suspected, sometimes without clinical symptoms. Retethering can occur and require reoperation due to the presentation of either recurrent or new symptoms. The purpose of this institutional review was to identify the retethering rate in children, especially in those who were initially asymptomatic, and to discuss the role of surgery. Methods: The medical records of all children at the Children's Hospital of Eastern Ontario (CHEO) who underwent tethered cord surgery between 1978 and 2009 for a thickened filum terminale were retrospectively reviewed, as well as those who retethered. Results: A total of 146 patients with a mean age of 4.3 years underwent a low lumbar single or partial laminectomy for sectioning of the filum terminale; 44 patients (30.1%) were asymptomatic at the time of surgery, 51.4% had bladder and bowel dysfunction, 26.7% had neuroorthopedic findings, 15.8% had pain and 6.2% had progressive scoliosis; 11 children with a median age of 8.9 years had symptoms of retethering requiring reoperation (median time to retether was 4.3 years) and 4 were initially asymptomatic. Repeat surgery was successful at alleviating the new symptoms that occurred as a result of retethering. Conclusions: Of the 146 patients at CHEO who underwent surgery, 7.5% retethered, with 36% being initially asymptomatic. Those operated in the first year of life were not found to be at a higher risk. The level of the conus medullaris did not influence the rate or retethering or urological dysfunction. Children who were initially asymptomatic improved after surgery for retethering, but may not have required surgery in the first place.

1.
Yong RL, Habrock-Bach TH, Vaughan M, Kestle JR, Steinbok P: Symptomatic retethering of the spinal cord after section of a tight filum terminale. Neurosurgery 2011;68:1594-1602.
2.
Hoffman HJ, Hendrick EB, Humphreys RP: The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Childs Brain 1976;2:145-155.
3.
Yamada S, Won DJ, Pezeshkpour G, Yamada BS, Yamada SM, Siddiqi J, Zouros A, Colohan AR: Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg Focus 2007;23:1-10.
4.
Lew SM, Kothbauer KF: Tethered cord syndrome: an updated review. Pediatr Neurosurg 2007;43:236-248.
5.
Garceau GJ: The filum terminale syndrome (the cord-traction syndrome). J Bone Joint Surg Am 1953;35-A:711-716.
6.
Haro H, Komori H, Okawa A, Kawabata S, Shinomiya K: Long-term outcomes of surgical treatment for tethered cord syndrome. J Spinal Disord Tech 2004;17:16-20.
7.
Inoue HK, Kobayashi S, Ohbayashi K, Kohga H, Nakamura M: Treatment and prevention of tethered and retethered spinal cord using a Gore-Tex surgical membrane. J Neurosurg 1994;80:689-693.
8.
Kang JK, Lee KS, Jeun SS, Lee IW, Kim MC: Role of surgery for maintaining urological function and prevention of retethering in the treatment of lipomeningomyelocele: experience recorded in 75 lipomeningomyelocele patients. Childs Nerv Syst 2003;19:23-29.
9.
Muthukumar N, Subramaniam B, Gnanaseelan T, Rathinam R, Thiruthavadoss A: Tethered cord syndrome in children with anorectal malformations. J Neurosurg 2006;92:626-630.
10.
Selden NR: Occult tethered cord syndrome: the case for surgery. J Neurosurg 2006;104:302-304.
11.
Unsinn KM, Geley T, Freund MC, Gassner I: US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics 2000;20:923-938.
12.
Chern JJ, Kirkman JL, Shannon CN, Tubbs RS, Stone JD, Royal SA, Oakes WJ, Rozzelle CJ, Wellons JC: Use of lumbar ultrasonography to detect occult spinal dysraphism. J Neurosurg Pediatr 2012;9:274-279.
13.
Steinbok P, Garton HJ, Gupta N: Occult tethered cord syndrome: a survey of practice patterns. J Neurosurg 2006;104:309-313.
14.
Cochrane DD: Occult spinal dysraphism; in Albright AL, Pollack IF, Adelson PD (eds): Principles and Practice of Pediatric Neurosurgery, ed 2. New York, Thieme, 2008, pp 367-393.
15.
Ogiwara H, Lyszczarz A, Alden TD, Bowman RM, McLone DG, Tomita T: Retethering of transected fatty filum terminales. J Neurosurg Pediatrics 2011;7:42-46.
16.
Bao N, Chen ZH, Gu S, Chen QM, Jin HM, Shi CR: Tight filum terminale syndrome in children: analysis based on positioning of the conus and absence or presence of lumbosacral lipoma. Childs Nerv Syst 2007;23:1129-1134.
17.
Komagata M, Endo K, Nishiyama M, Ikegami H, Imakiire A: Management of tight filum terminale. Minim Invasive Neurosurg 2004;47:49-53.
18.
Pierz K, Banta J, Thomson J, Gahm N, Hartford J: The effect of tethered cord release on scoliosis in myelomeningocele. J Pediatr Orthop 2000;20:362-365.
19.
Ostling LR, Bierbrauer KS, Kuntz C 4th: Outcome, reoperation, and complications in 99 consecutive children operated for tight or fatty filum. World Neurosurg 2012;77:187-191.
20.
Samuels R, McGirt MJ, Attenello FJ, Gracés Ambrossi GL, Singh N, Solakoglu C, Weingart JD, Carson BS, Jallo GI: Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty. Childs Nerv Syst 2009;25:1085-1089.
21.
Colak A, Pollack IF, Albright AL: Recurrent tethering: a common long-term problem after lipomyelomeningocele repair. Pediatr Neurosurg 1998;29:184-190.
22.
Al-Holou WN, Muraszko KM, Garton HJ, Buchman SR, Maher CO: The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome. J Neurosurg Pediatr 2009;4:28-36.
23.
Sakamoto H, Hakuba A, Fujitani K, Nishimura S: Surgical treatment of the retethered spinal cord after repair of lipomyelomeningocele. J Neurosurg 1991;74:709-714.
24.
Tamaki N, Shirataki K, Kojima N, Shouse Y, Matsumoto S: Tethered cord syndrome of delayed onset following repair of myelomeningocele. J Neurosurg 1988;69:393-398.
25.
Kanev PM, Lemire RJ, Loeser JD, Berger MS: Management and long-term follow-up review of children with lipomyelomeningocele, 1952-1987. J Neurosurg 1990;73:48-52.
26.
Herman JM, McLone DG, Storrs BB, Dauser RC: Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord: presentation, management and outcome. Pediatr Neurosurg 1993;19:243-249.
27.
Ohe N, Futamura A, Kawada R, Minatsu H, Kohmura H, Hayashi K, Miwa K, Sakai N: Secondary tethered cord syndrome in spinal dysraphism. Childs Nerv Syst 2000;16:457-461.
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