CHANGE IN SPINAL CURVATURE FOLLOWING RELEASE OF TETHERED SPINAL-CORD ASSOCIATED WITH SPINA-BIFIDA

Changes in spinal curvature, scoliosis, kyphosis and lordosis are asso ciated with the growth of patients with myelomeningocele. Previous inv estigators have stated that progressive developmental scoliosis is rel ated to tethered spinal cord. In order to investigate the relationship of tethered spinal cord release to progression of spinal curvature, w e surveyed the medical records of 262 patients with a history of one o r more tethered spinal cord release. For 216 of these patients, a tota l of 2,369 serial spine x-rays, obtained over a 20-year period, were r eviewed by the standard Cobb method for progression of scoliosis, thor acic kyphosis and lordosis. In addition, the serial spine x-rays of 74 patients without clinical findings of tethered spinal cord were colle cted and reviewed for comparison of progressive scoliosis and kyphosis . One hundred and sixty normal lumbar x-rays were evaluated to compare the progression of the lordotic curve in patients with tethered cord release with a normal population. Progression of scoliosis plateaued o r declined following release of tethered cord in patients with lumbar and sacral level lesions, however, tether release did not halt the pro gression of scoliosis in the thoracic level group. Tethered cord relea se altered the course of lordosis in L1 through L3 level lesions, but had little affect on the normal progression of lordosis in patients wi th L4, L5 or sacral level lesions. Finally, tethered spinal cord relea se appears to be associated with a decrease in the incidence and magni tude of kyphosis.