Analysis of different treatment modalities of tethered cord syndrome

Introduction: Although MRI has improved the diagnosis of tethered cord, many controversies still exist in the treatment of tethered cord syndrome (TCS). Especially the indications for and timing of surgical release have remained topics of discussion. Materials and methods: We retrospectively analysed a group of 41 spina bifida occulta (SBO) patients with a tethered cord to evaluate the results of treatment. Patients were divided into four groups. Twelve asymptomatic tethered cord patients underwent prophylactic surgery (group 1). Ten patients were operated upon because of progressive symptoms (group 2). In the third group 9 patients were treated conservatively at first, but underwent surgery after further progression of symptoms. The 10 patients in group 4 were treated conservatively. Results: The course of symptoms was analysed in the separate groups. Patients in group 1 remained stable during the mean follow-up of 5.7 years. Neurological symptoms appeared to improve most after early surgery (group 2), but progression of symptoms continued in spite of surgical release