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Systematic Review of Urologic Outcomes from Tethered Cord Release in Occult Spinal Dysraphism in Children

  • Pediatric Urology (M Castellan and R Gosalbez, Section Editors)
  • Published:
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Tethered cord syndrome describes a condition of multisystem end organ dysfunction due to fixation of the spinal cord. This systematic review focuses on the closed skin variant of this condition, occult spinal dysraphism. The embryology, pathophysiology, presentation, and classification of occult spinal dysraphism are explained to develop a simple framework for discussions regarding this often confusing condition. Following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we synthesized urologic outcome data after tethered cord release in children from 17 studies performed over the past 25 years. These results prompted several conclusions. First, the different subgroups and different nomenclature of tethered cord syndrome are often confused, making interpretation of results difficult. Second, untethering has a positive effect on urologic symptoms and urodynamics parameters. Third, timing of untethering is important: early intervention prevents significant long-term traction aiming to avoid irreversible neurologic damage. Fourth, pediatric urologists and neurosurgeons have an important role in diagnosing and treating this condition and should work closely as part of a multidisciplinary team.

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Bone morphogenetic protein


Caudal cell mass


Detrusor overactivity


Detrusor-sphincter dyssynergia


Fatty filum


Genitourinary system




Lower urinary tract




Neural tube defect


Occult spinal dysraphism


Occult tethered cord syndrome


Post-void residual


Spinal cord


Split cord malformation


Tethered cord release


Tethered cord syndrome


Urodynamic studies


Urinary tract infection


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Jeffrey T. White, Derek C. Samples, Juan C. Prieto, and Izabela Tarasiewicz each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Juan C. Prieto.

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This article is part of the Topical Collection on Pediatric Urology

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White, J.T., Samples, D.C., Prieto, J.C. et al. Systematic Review of Urologic Outcomes from Tethered Cord Release in Occult Spinal Dysraphism in Children. Curr Urol Rep 16, 78 (2015).

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