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.