415 Cryopreserved Human Umbilical Cord in the Treatment of Pediatric Tethered Cord Syndrome

Abstract

INTRODUCTION: Tethered cord syndrome (TCS) is characterized by neurological, gastrointestinal/genitourinary, and musculoskeletal dysfunction attributable to spinal cord traction. It is estimated that 20-50% of children with open and closed neural tube defects repaired after birth will require surgery to detether the spinal cord. The cryopreserved human umbilical cord (HUC) patch has regenerative, anti-inflammatory, and anti-scarring properties. In animal models, when HUC is used as a meningeal patch it allows regeneration of the arachnoid layer, prevents spinal cord tethering, and improves spinal cord function after in utero spina bifida repair. We hypothesized that this would benefit pediatric patients requiring detethering. METHODS: Serial patients with clinical and radiographic evidence of a tethered cord were enrolled following informed consent. At the time of surgery they underwent spinal cord detethering with neuromonitoring. At the time of closure a HUC graft (Clarix 1k) was placed as a dural underlay, the dura was closed primarily, and a second graft was placed as a dural overlay and sealed with tissue sealant. Serial neurologic assessments and urologic assessments were obtained. MRIs are performed annually or as indicated clinically. RESULTS: Four patients have been detethered with use of HUC as a dural underlay and overlay (2 lipomyelomeningocele, 1 lipoma/diastematomyelia, 1 tethered cord). One patient remains neurointact, with resolution of mild neurogenic bladder. Another patient has gained sensation of lower extremities, sensation to catheterization, with resolution of neurogenic bowel and bladder. One has gained sensation to catheterization, with resolution of neurogenic bowel and bladder. The fourth patient is stable. CONCLUSIONS: Early use of HUC as a dural underlay and overlay during closure for tethered cord surgery shows promise in improving spinal cord function in pediatric patients.