Symptomatic and Urodynamic Outcomes After Spinal Cord De‐Tethering in Primary Tethered Cord Patients

INTRODUCTION: It is controversial whether surgical correction of tethered spinal cord in non-myelomeningocele tethered cord patients results in reversal versus stabilization of urologic (GU), gastrointestinal (GI), and musculoskeletal (MSK) symptoms. OBJECTIVE: To determine factors associated with clinical improvement in symptoms after spinal cord de-tethering, and evaluate whether pre-operative urodynamic testing predicts post-operative clinical outcomes. METHODS: 213 non-myelomeningocele children who underwent primary spinal cord de-tethering at a quaternary children's hospital from 2012 to 2020 were retrospectively reviewed. Age at surgery, gender, and presence of GU symptoms, constipation, MSK symptoms, and urodynamic studies were collected. Pre-operative symptoms and demographics were compared between patients with and without resolution of GU symptoms after surgery. RESULTS: Mean age at surgery was 5.36 years, 48% were female, and mean length of follow up was 1.8 years. Before surgery, 133/213 (62%) experienced a GU symptom. 105/213 (49%) patients were potty-trained. Of 105 potty-trained patients, 50 (48%) had daytime incontinence and 55 (52%) had nocturnal enuresis. Of 88 potty-trained patients with urinary symptoms, 22 (25%) had resolution of and 59 (67%) had improvement following surgery. Of the 102 with constipation, 45 (44%) had improvement. Of the 116 with musculoskeletal symptoms, 60 (52%) had improvement. Patients with resolution of GU symptoms were younger (4.97 vs. 8 years, p = 0.0019). Patients with daytime urinary incontinence (p = 0.0119) were less likely to have resolution of GU symptoms. There was no difference in urodynamic findings between patients with and without improvement or resolution of urologic symptoms. CONCLUSION: Younger age at de-tethering surgery is associated with improvement in genitourinary symptoms. Preoperative urodynamic studies may not be predictive of postoperative outcomes.