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010. Predictors of outcome in patients with occult tethered cord; beyond the fatty filum and low-lying conus

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Authors: Ahmed Helal, MBBCh

Introduction:
Diagnosis of occult tethered cord syndrome (OTCS) in patients with an MRI-normal filum terminale who present with urological and neurological symptoms is controversial. In order to better understand the indications for surgical filum release in this population we reviewed our experience to identify predictors of clinical improvement.Methods: A retrospective review identified all patients admitted for surgical filum release between January 2015 and December 2019. Patients with a low-lying conus or fatty filum were excluded. Patients with less than 3 months of follow-up were excluded. Data collected included baseline demographics, presenting features, MRI findings, and urodynamic findings. Analysis was performed to determine predictors of any improvement or resolution of symptoms.
Results:
Eighty-nine patients were included in our study with an average age of 8.2 ± 3.7 years and a 1.7:1 female to male ratio. Seventy-nine (89%) patients presented with bowel and bladder symptoms and 57 (64%) with pain. Tight heel cords and lower extremity asymmetry were present in 45 (50.5%) and 43(48.3%) of patients respectively. Eight (9%) patients had Chiari malformations, 22 (24.7%) an associated syrinx, and 10 (11.2%) presented with scoliosis. Sixty-six patients (74.2%) improved, 15 (16.9%) completely. Pre-operative pain, tight heel cords and presence of syrinx were significantly correlated with post-operative total symptom resolution. Tight heel cords and decreased bladder sensation on urodynamic studies were significantly correlated with recovery of bladder symptoms.
Conclusion:
OTCS presents a diagnostic challenge in which surgical intervention may provide potential benefit in properly selected patients. This study has shed light on several predictive parameters for post-operative symptomatic improvement and thus patient selection. Further prospective randomized studies are necessary to better understand this complex disease entity and determine the impact of operative management on patients’ quality of life.