Tethered cord syndrome in patients with myelomeningocele: Presentation of 3 cases, technical note on re-anchoring without dural opening.

Abstract

Background: Following myelomeningocele (MMC) repair, 10-30% of patients develop tethered cord syndrome (TCS). Surgical intervention is critical to reverse the stretching of the spinal cord. Here, we describe a technique for spinal cord untethering without dural opening in these patients.

Methods: Three patients underwent spinal cord untethering without dural opening. The surgical technique involved reopening the previous incision and dissecting the scar tissue attached to the dura. A Spongostan sponge was inserted, and lateral sutures were placed between the dural sac and the adjacent muscles. Clinical outcomes, imaging findings, and urodynamic results were evaluated postoperatively.

Results: The technique demonstrated positive outcomes in all three cases. Patients showed symptom improvement, better positioning of the spinal cord on imaging studies, and enhanced bladder function on urodynamic evaluations.

Conclusion: Spinal cord re-untethering without dural opening may be a viable surgical option for selected patients with MMC, offering favorable outcomes with reduced risk.