109 Radiographic and Clinical Follow-up of Syringomyelia in Patients Treated for Tethered Cord Syndrome without Other Radiographic Abnormalities

Abstract

INTRODUCTION: The management of patients with symptoms of tethered cord syndrome (TCS) who lack significant radiographic abnormalities is controversial (1,2,3). One potential marker for TCS is syringomyelia (4,5). However, a syrinx may be a benign and incidental finding (6,7). We evaluate a highly selected cohort of patients who had symptoms of TCS with minimal radiographic abnormalities other than syringomyelia. We evaluate clinical and radiographic outcomes after tethered cord release (TCR). METHODS: A retrospective review of 16 children meeting inclusion criteria was performed. All patients were surgically treated at the Riley Hospital for Children in Indianapolis, Indiana between 2006 and 2011. All children had clinical symptoms of TCS with pre- and post-operative MRI and clinical evaluation. RESULTS: The most common presentation (12/16, 75%) was urinary dysfunction, defined as symptoms of urgency or incontinence with abnormal urodynamic studies. Clinical follow-up was available on 11 of these twelve patients. All 11 had improvement in symptoms at average follow-up of 1.4 years. Seven of 8 patients (87.5%) presenting with back or leg pain had improvement. Four patients had progressive scoliosis. Three had stabilization of the curve or mild improvement, and one had worsening deformity. Radiographic follow-up was obtained an average of 1.2 years after surgery. Twelve patients (75%) had stable syringomyelia after TCR. Four patients showed improvement, with two having complete radiographic resolution. CONCLUSION: Highly selected patients with symptoms of TSC do very well clinically. Patients with abnormal urodynamic studies, pain, and gait disturbances show a high rate of symptomatic improvement. However, a smaller percentage of patients had radiographic improvement of the syrinx. Therefore, we suggest that the decision for TCR should be based on clinical symptoms in this population. Symptomatic improvement is not necessarily related to radiographic resolution of the syrinx.