Skip to main content

Advertisement

Log in

Growth profile assessment of young adults with tethered cord syndrome: a retrospective cohort analysis of Korean conscription data

  • Original Article
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Tethered cord syndrome (TCS) is characterized by progressive spinal cord degeneration secondary to congenital spinal dysraphism. The associated accompanying physical inactivity and musculoskeletal deformities have raised interest in the growth profile of adult TCS patients. However, few previous studies have investigated the growth profile of adult TCS patients.

Methods

We retrospectively reviewed the demographic data and medical records of 20-year-old Korean conscription examinees who were registered between April 2004 and September 2019. In total, 151 examinees with a diagnosis of TCS were enrolled. The height, weight, and body mass index (BMI) of 300 randomly selected examinees were compared to the TCS group. Obesity was defined by the World Health Organization and Asian-Pacific criteria for BMI and compared between the groups. Growth profile differences according to tethering location and musculoskeletal deformities were analyzed in both groups.

Results

The mean height, weight, and BMI values of the TCS group were lower than those of the control group. The TCS group had a lower proportion of obese and overweight individuals, and a higher proportion of underweight individuals, according to both BMI criteria. The tethering level was not associated with the degree of obesity in the tethered group. The mean height, weight, and BMI were lower in the tethered group regardless of the existence of musculoskeletal deformity.

Conclusion

Enrollees with a history of TCS were smaller than controls of the same age. Monitoring of health behaviors, including nutrition, diet, and exercise, is warranted for TCS patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

TCS:

tethered cord syndrome

BMI:

body mass index

WHO:

World Health Organization

MMC:

myelomeningocele

GHD:

growth hormone deficiency

References

  1. Alriksson-Schmidt AI, Thibadeau JK, Swanson ME, Marcus D, Carris KL, Siffel C, Ward E (2013) The natural history of spina bifida in children pilot project: research protocol. JMIR Res Protoc 2:e2

    Article  PubMed  PubMed Central  Google Scholar 

  2. Apkon SD, Grady R, Hart S, Lee A, McNalley T, Niswander L et al (2014) Advances in the care of children with spina bifida. Adv Pediatr Infect Dis 61:33–74

    Google Scholar 

  3. Asher M, Olson J (1983) Factors affecting the ambulatory status of patients with spina bifida cystica. J Bone Joint Surg Am 65:350–356

    Article  CAS  PubMed  Google Scholar 

  4. Begeer JH, Schreinemachers AL, Terwisga PH (1992) Growth and the tethered cord syndrome. Eur J Pediatr Surg Suppl 1:23–25

    Article  Google Scholar 

  5. Boudos RM, Mukherjee S (2008) Barriers to community participation: teens and young adults with spina bifida. J Pediatr Rehabil Med 1:303–310

    PubMed  Google Scholar 

  6. Campbell J, Bonnett C (1975) Spinal cord injury in children. Clin Orthop Relat Res 112:114–123

    Article  Google Scholar 

  7. Cicmil N, Eli K (2014) Body image among eating disorder patients with disabilities: a review of published case studies. Body Image 11:266–274

    Article  PubMed  Google Scholar 

  8. Claridge EA, Bloemen MAT, Rook RA, Obeid J, Timmons BW, Takken T, van den Berg-Emons RJG, de Groot JF, Gorter JW (2019) Physical activity and sedentary behaviour in children with spina bifida. Dev Med Child Neurol 61:1400–1407

    Article  PubMed  Google Scholar 

  9. Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GN, Shaw GM (2015) Spina bifida. Nat Rev Dis Primers 1:15007

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dicianno BE, Karmarkar A, Houtrow A, Crytzer TM, Cushanick KM, McCoy A, Wilson P, Chinarian J, Neufeld J, Smith K, Collins DM (2015) Factors associated with mobility outcomes in a National Spina Bifida Patient Registry. Am J Phys Med Rehabil 94:1015–1025

    Article  PubMed  PubMed Central  Google Scholar 

  11. Dosa NP, Foley JT, Eckrich M, Woodall-Ruff D, Liptak GS (2009) Obesity across the lifespan among persons with spina bifida. Disabil Rehabil 31:914–920

    Article  PubMed  Google Scholar 

  12. Duval-Beaupere G, Kaci M, Lougovoy J, Caponi M, Touzeau C (1987) Growth of trunk and legs of children with myelomeningocele. Dev Med Child Neurol 29:225–231

    Article  CAS  PubMed  Google Scholar 

  13. Duval-Beaupere G, Lougovoy J, Trocellier L, Lacert P (1983) Trunk and leg growth in children with paraplegia caused by spinal cord injury. Paraplegia 21:339–350

    CAS  PubMed  Google Scholar 

  14. Filippidis AS, Kalani MY, Theodore N, Rekate HL (2010) Spinal cord traction, vascular compromise, hypoxia, and metabolic derangements in the pathophysiology of tethered cord syndrome. Neurosurg Focus 29:E9

    Article  PubMed  Google Scholar 

  15. Foster KA, Lam S, Lin Y, Greene S (2014) Putative height acceleration following tethered cord release in children. J Neurosurg Pediatr 14:626–634

    Article  PubMed  Google Scholar 

  16. Gullickson G Jr, Olson M, Kottke FJ (1950) The effect of paralysis of one lower-extremity on bone growth. Arch Phys Med Rehabil 31:392–400

    PubMed  Google Scholar 

  17. Hayashi T, Takemoto J, Ochiai T, Kimiwada T, Shirane R, Sakai K, Nakagawa H, Tominaga T (2013) Surgical indication and outcome in patients with postoperative retethered cord syndrome. J Neurosurg Pediatr 11:133–139

    Article  PubMed  Google Scholar 

  18. Kang JK, Kim MC, Kim DS, Song JU (1987) Effects of tethering on regional spinal cord blood flow and sensory-evoked potentials in growing cats. Childs Nerv Syst 3:35–39

    Article  CAS  PubMed  Google Scholar 

  19. Lin T, Tong W, Chandra A, Hsu SY, Jia H, Zhu J, Tseng WJ, Levine MA, Zhang Y, Yan SG, Liu XS, Sun D, Young W, Qin L (2015) A comprehensive study of long-term skeletal changes after spinal cord injury in adult rats. Bone Res 3:15028

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. McGirt MJ, Mehta V, Garces-Ambrossi G, Gottfried O, Solakoglu C, Gokaslan ZL et al (2009) Pediatric tethered cord syndrome: response of scoliosis to untethering procedures. J Neurosurg Pediatr 4:270–274

    Article  PubMed  Google Scholar 

  21. McLone DG, Herman JM, Gabrieli AP, Dias L (1990) Tethered cord as a cause of scoliosis in children with a myelomeningocele. Pediatr Neurosurg 16:8–13

    Article  PubMed  Google Scholar 

  22. McPherson AC, Swift JA, Yung E, Lyons J, Church P (2013) The assessment of weight status in children and young people attending a spina bifida outpatient clinic: a retrospective medical record review. Disabil Rehabil 35:2123–2131

    Article  PubMed  PubMed Central  Google Scholar 

  23. Michelson DJ, Ashwal S (2004) Tethered cord syndrome in childhood: diagnostic features and relationship to congenital anomalies. Neurol Res 26:745–753

    Article  PubMed  Google Scholar 

  24. Mita K, Akataki K, Itoh K, Ono Y, Ishida N, Oki T (1993) Assessment of obesity of children with spina bifida. Dev Med Child Neurol 35:305–311

    Article  CAS  PubMed  Google Scholar 

  25. Morse L, Teng YD, Pham L, Newton K, Yu D, Liao WL, Kohler T, Müller R, Graves D, Stashenko P, Battaglino R (2008) Spinal cord injury causes rapid osteoclastic resorption and growth plate abnormalities in growing rats (SCI-induced bone loss in growing rats). Osteoporos Int 19:645–652

    Article  CAS  PubMed  Google Scholar 

  26. Morse LR, Xu Y, Solomon B, Boyle L, Yoganathan S, Stashenko P, Battaglino RA (2011) Severe spinal cord injury causes immediate multi-cellular dysfunction at the chondro-osseous junction. Transl Stroke Res 2:643–650

    Article  PubMed  PubMed Central  Google Scholar 

  27. Oh CH, Yoon SH, Park H-C, Park CO, Kim SY (2014) A comparison of the somatometric measurements of adolescent males with and without idiopathic scoliosis. J Spinal Disord Tech 27:E26–E31

    Article  PubMed  Google Scholar 

  28. O’Neill BR, Yu AK, Tyler-Kabara EC (2010) Prevalence of tethered spinal cord in infants with VACTERL. J Neurosurg Pediatr 6:177–182

    Article  PubMed  Google Scholar 

  29. O’Neil J, Fuqua JS (2020) Short stature and the effect of human growth hormone: guidelines for the care of people with spina bifida. J Pediatr Rehabil Med Epub ahead of print

  30. Opitz JM (2005) Genetics of tethered cord “syndrome”: the FG syndrome. Am J Med Genet A 132A:454–455

    Article  CAS  PubMed  Google Scholar 

  31. Pinquart M (2013) Body image of children and adolescents with chronic illness: a meta-analytic comparison with healthy peers. Body Image 10:141–148

    Article  CAS  PubMed  Google Scholar 

  32. Polfuss M, Bandini LG, Sawin KJ (2017) Obesity prevention for individuals with spina bifida. Curr Obes Rep 6:116–126

    Article  PubMed  Google Scholar 

  33. Reigel DH, Tchernoukha K, Bazmi B, Kortyna R, Rotenstein D (1994) Change in spinal curvature following release of tethered spinal cord associated with spina bifida. Pediatr Neurosurg 20:30–42

    Article  CAS  PubMed  Google Scholar 

  34. Ring PA (1957) Shortening and paralysis in poliomyelitis. Lancet 273:980–983

    Article  CAS  PubMed  Google Scholar 

  35. Rotenstein D, Adams M, Reigel DH (1995) Adult stature and anthropomorphic measurements of patients with myelomeningocele. Eur J Pediatr 154:398–402

    Article  CAS  PubMed  Google Scholar 

  36. Rotenstein D, Reigel DH, Lucke JF (1996) Growth of growth hormone-treated and nontreated children before and after tethered spinal cord release. Pediatr Neurosurg 24:237–241

    Article  CAS  PubMed  Google Scholar 

  37. Samuels R, McGirt MJ, Attenello FJ, Ambrossi GLG, Singh N, Solakoglu C et al (2009) Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty. Childs Nerv Syst 25:1085–1089

    Article  PubMed  Google Scholar 

  38. Sanz Cortes M, Davila I, Torres P, Yepez M, Lee W, Guimaraes CV, Sangi-Haghpeykar H, Whitehead WE, Castillo J, Nassr AA, Espinoza J, Shamshirsaz AA, Belfort MA (2019) Does fetoscopic or open repair for spina bifida affect fetal and postnatal growth? Ultrasound Obstet Gynecol 53:314–323

    Article  CAS  PubMed  Google Scholar 

  39. Segal LS, Czoch W, Hennrikus WL, Wade Shrader M, Kanev PM (2013) The spectrum of musculoskeletal problems in lipomyelomeningocele. J Child Orthop 7:513–519

    Article  PubMed  PubMed Central  Google Scholar 

  40. Shepherd K, Roberts D, Golding S, Thomas B, Shepherd RJT (1991) Body composition in myelomeningocele. Am J Clin Nutr 53:1–6

    Article  CAS  PubMed  Google Scholar 

  41. Silber TJ, Shaer C, Atkins D (1999) Eating disorders in adolescents and young women with spina bifida. Int J Eat Disord 25:457–461

    Article  CAS  PubMed  Google Scholar 

  42. Stetler WR, Park P, Sullivan S (2010) Pathophysiology of adult tethered cord syndrome: review of the literature. Neurosurg Focus 29:E2

    Article  PubMed  Google Scholar 

  43. Stiles-Shields C, Holmbeck GN (2019) Health behaviors and disordered eating in adolescents and young adults with spina bifida: results from a national survey. Disabil Rehabil 12:1–7

    Google Scholar 

  44. Taleporos G, McCabe MP (2005) The relationship between the severity and duration of physical disability and body esteem. Psychol Health 20:637–650

    Article  Google Scholar 

  45. Tanaka T, Ling BC, Rubinstein JH, Crone KR (2006) Rubinstein-Taybi syndrome in children with tethered spinal cord. J Neurosurg 105:261–264

    PubMed  Google Scholar 

  46. Trollmann R, Dörr HG, Strehl E, Katalinic A, Beyer R, Wenzel D (1996) Growth and pubertal development in patients with meningomyelocele: a retrospective analysis. Acta Paediatr 85:76–80

    Article  CAS  PubMed  Google Scholar 

  47. Valentini LG, Babini M, Cordella R, Beretta E, Destro F, Murabito P, et al (2020) Early de-tethering: analysis of urological and clinical consequences in a series of 40 children. Childs Nerv Syst Epub ahead of print

  48. Yamada S, Won DJ, Yamada SM (2004) Pathophysiology of tethered cord syndrome: correlation with symptomatology. Neurosurg Focus 16:1–5

    Article  Google Scholar 

  49. Yong RL, Habrock-Bach T, Vaughan M, Kestle JR, Steinbok P (2011) Symptomatic retethering of the spinal cord after section of a tight filum terminale. Neurosurgery 68:1594–1602

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hyun Iee Shin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval and consent to participate

As this study was a registry-based retrospective cohort study, informed consent was not obtained.

Consent to publication

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, S.H., Shin, H.I., Nam, TK. et al. Growth profile assessment of young adults with tethered cord syndrome: a retrospective cohort analysis of Korean conscription data. Childs Nerv Syst 37, 1973–1981 (2021). https://doi.org/10.1007/s00381-020-05026-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-020-05026-2

Keywords

Navigation