ANALYSIS OF 153 PATIENTS WITH MYELOMENINGOCELE OR SPINAL LIPOMA REOPERATED UPON FOR A TETHERED CORD - PRESENTATION, MANAGEMENT AND OUTCOME

After primary repair of myelomeningoceles or lipomyelomeningoceles, la te progressive neurologic deterioration commonly occurs due to a treat able cause. In our experience many of these patients have a tethered c ord. With early untethering, most patients are stabilized and a signif icant percent of the patients show improvement in their clinical statu s. Of 341 tethered cord releases done from 1981 to 1988, we report on 153 patients reoperated upon following primary repair. One hundred wer e performed after primary closure of a myelomeningocele and 53 after r epair of a lipomyelomeningocele. The average age of the patients with a myelomeningocele was 6 years old, and for the spinal lipoma patients , 8 years old. The presenting symptoms were similar; weakness, deterio ration in gait, scoliosis, orthopedic deformities, and urinary inconti nence represented the most common complaints. All 153 patients were no ted to have a tethered cord at operation. Additional pathology (dermoi d tumors, hydromyelia, tight filum and diastematomyelia) was present i n 30% of the cases. With the use of the CO2 laser for dissection, all but 10 patients could be untethered. Follow-up over an average of 4 ye ars revealed 93% of the patients with a myelomeningocele had stabiliza tion or improvement of their presenting complaints, and 7% had progres sion of their presenting complaints. All of the lipomyelomeningocele p atients had either stabilization or improvement of their presenting co mplaints. There were no mortalities. Close follow-up and early treatme nt of this patient population is indicated. With release of the cord a significant portion of the population will have relief or improvement of their presenting complaints.