The complications arising from surgically treating a tethered spinal cord depend on several factors. The most important of these is the patient's age, where young children have the best prognosis for symptomatic relief. However, the extent of the adhesions and the patient's general health play important roles in expected outcomes. Even though postoperative complications have become less common thanks to new surgical procedures, they can still occur.
Genitourinary and Bowel Dysfunction
Of all the postoperative complications of tethered spinal cord surgery, the most prevalent is an atonic bladder. This is when the bladder loses muscular tone as a result of damaging the spinal roots controlling bladder function. Certain procedures such as partial untethering help minimize this complication. Also, electronically monitoring neural activity is used to try and identify obscured spinal roots or neural tissue at risk of being traumatized. However, in spite of using such electronic techniques, the prevalence of atonic bladder complications has not been proven to decrease, according to a 2007 article in the journal "Neurosurgical Focus." Similarly, bowel and sexual dysfunction may result, and these complications can be transient or permanent.
Cerebrospinal Fluid Leakage
Another complication of tethered spinal cord surgery is cerebrospinal fluid leakage. The membranes covering the spinal cord and the spinal roots form a sac surrounding the neural tissues and bathe them in cerebrospinal fluid. The cerebrospinal fluid serves multiple functions, including nutrition and mechanical cushioning for the delicate neural tissues. As reported in a 2007 article in the journal "Neurosurgical Focus," when adhesions and other tissues are surgically removed, the membrane often thins out. The membrane can become so thin that it requires patching either with other tissue or with artificial material in order to seal the defect. If the defect is not sealed and cerebrospinal fluid continues to leak, the neural tissue directly below the defect, or sometimes in other places, can erode and become permanently damaged. This produces neurological impairment.
Retethering
According to a 2006 report in the "Journal of Neurosurgery," another complication of tethered spinal cord surgery is retethering. This is also called revision surgery and occurs because at times the very act of surgical manipulation produces local fibrous adhesions. These can thicken and form new tethers to the spinal cord resulting in a return of symptoms. Retethering occurs most often in pediatric rather than adult patients. Studies show that pediatric retethering occurs as much as 57 percent of the time, whereas the adult retethering rate is about 16 percent, according to the report.
References
- "Neurosurgical Focus"; Surgical Management of the Tethered Spinal Cord; J. Drake; October 2007
- Long Island Neurological Association: Laminectomy for Tethered Cord
- "Neurosurgical Focus"; Spinal Cord Transection; J. Blount, et al.; August 2007
- "Neurosurgical Focus"; Spinal Lipomas: Clinical Spectrum, Embryology and Treatment; M. Finn and M. Walker; August 2007
- "Journal of Neurosurgery"; Surgical Management of Tethered Cord Syndrome in Adults: Indications, Techniques and Long-Term Outcomes in 60 Patients; G. Lee, et al.; February 2006
