Patients with urinary incontinence often benefit from surgical detetheringof tight filum terminale

We retrospectively reviewed 77 patients with a tethered spinal cord syndrom e to evaluate the results of neurosurgical treatment. The patients were div ided into two groups: in group 1 there were 17 patients with primary tether ed cord who had normal level conus medullaris (NLCM) and normal thickness f ilum terminale (NTFT) with urinary incontinence, and group was made up of 6 0 patients with secondary spinal cord tethering after a previous closure of a midline fusion defect who had a low-lying conus medullaris. Neurological examination, radiography, urodynamic tests and electrophysiological findin gs confirmed the diagnosis. Conventionally, tethered cord syndrome has been defined as a state in which the conus medullaris is located below the L1-2 disc space. However. in a patient with urinary incontinence and a hyper-re flexive type of neurogenic bladder, in whom the conus medullaris is found t o be at the normal level, there may still be cord tethering that is causing the incontinence. In this study the comparison was based on evaluation of the response to treatment and general characteristics of the syndrome in bo th groups of patients to draw attention to the general approach to this inc apacitating maldevelopment.