Outcome, Reoperation, and Complications in 99 Consecutive Children Operated for Tight or Fatty Filum

Objective: Recent studies have suggested that retethering in patients operated for a tight or fatty filum is higher than previously predicted. In this retrospective review, outcome, complications, and risk of reoperation for recurrent tethered cord syndrome (TCS) at our own institution were investigated.

Methods: The medical records of 100 consecutive children who underwent initial division of the filum terminale at Cincinnati Children's Hospital Medical Center (November 1995-May 2006) for a tight or fatty filum were reviewed. One patient was excluded due to previous spinal surgery at an outside institution. Presenting symptoms/signs, magnetic resonance imaging findings, complications, postoperative symptoms/signs, and need for reoperation were recorded. Mean follow-up for 97 of the 99 patients was 33 months; 80 were followed for 6 months or more and 68 were followed for 12 months or more.

Results: The most common presenting symptoms were bladder and/or bowel dysfunction, followed by gait abnormality, back pain, and spasticity. At last follow-up, 85 patients were improved or stable, whereas 12 patients had at least one symptom or sign that had worsened. Five children required a second operation for recurrent TCS. Mean time to reoperation was 58 months (range 22-73 months). Arachnoid adhesions accounted for the retethering in four of five patients. There were a total of 12 complications in 9 patients including 5 wound infections, 4 cerebrospinal fluid leaks, 1 pseudomeningocele, 1 stitch abscess, and 1 transient headache.

Conclusions: Division of a tight or fatty filum, in this consecutive series of pediatric patients, resulted in improved or stable neurological symptoms in 88% of patients. However, the complication and reoperation rate for recurrent TCS were not insignificant. Future studies aimed at reducing complications and retethering in this population may be warranted.