IMPACT OF URODYNAMIC STUDIES ON THE SURGICAL-MANAGEMENT OF SPINAL-CORD TETHERING

To determine the usefulness of urodynamic studies in the management of children with a suspected tethered spinal cord, the authors retrospec tively reviewed case records of 25 patients evaluated both pre- and po stoperatively using this diagnostic adjunct. All patients were also ev aluated with magnetic resonance imaging or computerized tomography mye lography. Seven patients who presented initially with orthopedic defor mity, skin stigmata, and neurological problems underwent primary cord untethering (Group 1). All seven patients were urologically asymptomat ic; all but one had normal findings on urodynamic study. Eighteen pati ents with prior myelomeningocele closure underwent secondary untetheri ng (Group 2). They presented with urological (11 cases), neurological (three cases), or both urological and neurological (four cases) deteri oration. All patients underwent surgery via a microsurgical technique. At a mean follow-up time of 2 years, the only Group 1 patient with pr eoperative abnormal urodynamic findings normalized following untetheri ng, whereas another asymptomatic patient showed worsened results on hi s postoperative study. In Group 2, all seven patients with preoperativ e neurological deterioration improved. Ten of the 15 patients who had isolated or associated preoperative clinical urological deterioration improved or stabilized, whereas five displayed continued deterioration in their bladder function. With respect to urodynamic studies, there was a significant increase in total and pressure-specific bladder capa cities following untethering. We conclude that urodynamic studies are useful both diagnostically and in follow-up examinations of patients w ith tethered cord, that disturbances identified by these studies often precede clinical manifestations of deterioration, and that spinal cor d untethering favorably influences the urological status in most patie nts.