Tethered Cord Syndrome in the Pediatric-Adolescent Gynecologic Patient

Abstract

Study ObjectiveTo describe how pediatric and adolescent patients present to the gynecologist when they have tethered cord syndrome (TCS). DesignWe conducted a retrospective chart review on all patients suspected by the gynecologist of having TCS. SettingSingle pediatric and adolescent gynecology clinic in a mid-sized city in the midwest. ParticipantsThirty-two patients, first seen between 2005 and 2012, suspected of having TCS and for whom follow-up information was available. Interventions and Main Outcome MeasuresPatient characteristics, including patient history, gynecologic clinical indicators, clinical outcomes, indications for surgery, and postoperative resolution of symptoms, were reviewed. ResultsThe initial review of systems indicated stress urinary incontinence, back pain, and constipation as common markers in the 32 patients who were suspected of having TCS. All 32 patients underwent lumbar magnetic resonance imaging without contrast and evaluation by neurosurgery. Of the 32 patients with suspected TCS, 18 were later confirmed and 14 were shown to not have TCS. Of the 18 patients with sufficient information to justify a detethering procedure, 14 patients were followed and 93% (13 patients) had complete resolution of symptoms. Final diagnosis in the non-TCS group varied, including vulvovaginitis, enuresis, chronic constipation, and lichen sclerosis. Symptoms improved with the treatment of each primary condition. ConclusionsTCS symptoms overlap with gynecologic conditions; therefore, patients with TCS may present initially to the gynecologist. In pediatric/adolescent patients, TCS should be considered when stress urinary incontinence, back pain, and constipation are discovered in the review of systems. Because possible irreversible ischemic and neurologic changes are believed to be involved, early diagnosis and surgery are crucial for resolution. Providers should be aware of TCS in these pediatric and adolescent settings, because quick assessment may result in complete resolution of a chronic progressive disease.