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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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Abstract

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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Abbreviations

BMP:

Bone morphogenetic protein

CCM:

Caudal cell mass

DO:

Detrusor overactivity

DSD:

Detrusor-sphincter dyssynergia

FF:

Fatty filum

GUS:

Genitourinary system

LMMC:

Lipomyelomeningocele

LUT:

Lower urinary tract

MMC:

Myelomeningocele

NTD:

Neural tube defect

OSD:

Occult spinal dysraphism

OTCS:

Occult tethered cord syndrome

PVR:

Post-void residual

SC:

Spinal cord

SCM:

Split cord malformation

TCR:

Tethered cord release

TCS:

Tethered cord syndrome

UDS:

Urodynamic studies

UTI:

Urinary tract infection

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

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Conflict of Interest

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). https://doi.org/10.1007/s11934-015-0550-6

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