Investigation of the operation time in children with tethered cord syndrome

Abstract

Objectives To investigate the operation time in children with tethered cord syndrome and to search for the evidence of the evidence-based medicine of prophylactic surgery in tethered cord syndrome. Methods The clinical data of 145 children with tethered cord syndrome admitted to the Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University from January 2011 to December 2013 were analyzed retrospectively. The age at presentation was 1 day to 13 years (mean 38.6±3.4 months), 93 of them were males and 52 were females. The follow-up time was 24 months. Their preoperative symptoms were documented according to 4 categories: focal symptoms, bladder and/or rectal symptoms, symptoms of motor function impairment, and other symptoms. The follow-up was conducted by means of questionnaire survey after procedure. At 1, 3, 6, 9, 12, and 24 months after procedure, they came to hospital and a questionnaire survey was conducted by the follow-up specialists. They were documented and divided into excellent (no postoperative symptoms), improvement, no improvement, and aggravation (worse or having new symptoms), respectively according to whether their preoperative and postoperative symptoms were improved or not. Results In the preoperative symptoms, 73 patients (50.3%) had focal symptoms, 41 (28.3%) had bladder and/or rectal symptoms, 21 (14.5%) had motor function impairments, and 10 (6.7%) had other symptoms. During the follow-up after procedure, 59.3% (86/145) were excellent, 24.1% (35/145) were effective, 9.7% (14/145) were ineffective, and 6.9%(10/145) were aggravated. The statistical analysis showed that in children with focal symptoms before operation, the postoperative excellent rate was significantly higher than the children having symptoms before procedure (97.3% vs. 20.9%; P<0.05). Conclusions Children with tethered cord syndrome should be treated surgically in the presence of the symptoms of nervous system damage. It is recommended to complete the operation before 24 months. The safety of the preventive operation is higher and the clinical effect is satisfactory. Key words: Tethered cord syndrome; Neurosurgical procedures; Operation timing; Follow-up; Child