ELECTROPHYSIOLOGICAL AND URODYNAMIC STUDIES TO MONITOR SURGICAL OUTCOME IN CHILDREN WITH TETHERED SPINAL-CORDS

Children with myelodysplasia often develop tethering of their spinal c ord within 2-3 years after correction of their initial birth defect, l eading to either neurological or urological dysfunction. Surveillance of these children includes electrophysiologic/urodynamic (EMG/UDS) stu dies to monitor improvement or deterioration of their neurourological function, We reviewed 39 patients who underwent surgical untethering f rom 1979 to 1994 to determine whether postoperative EMG/UDS studies we re useful in assessing outcome after surgery. All patients had a compl ete neurologic examination and an EMG/UDS prior to and 3 months after surgery, Twenty patients (51%) showed improvement in their EMG/UDS stu dy after untethering, 15 (39%) demonstrated no significant change, and 4 (10%) showed deterioration, Improvement consisted of either return of previously absent motor units, return of sacral reflexes, or improv ed bladder dynamics. In a further 3 patients, subsequent deterioration on serial postoperative EMG/UDS testing was the first indication of r ecurrent tethering, We conclude that serial EMG/ UDS evaluation in pat ients at risk for tethering of the spinal cord may serve as a useful a djunct to close clinical observation. (C) 1995 John Wiley & Sons, Inc.