# Tethered Cord Syndrome in Pediatric and Adult Populations: A Retrospective Analysis of Outcomes and Associated Spinal Dysraphisms

## TL;DR

This study examines surgical outcomes for tethered cord syndrome in children and adults in Pakistan, finding neurological improvements with few complications.

## Contribution

The study provides insights into the clinical outcomes of surgical detethering for TCS in a Pakistani population, comparing pediatric and adult cases.

## Key findings

- Neurological improvement was observed in 75% of pediatric patients and 55.55% of adults after surgery.
- Lipomyelomeningocele was the most common spinal dysraphism in children, while thickened filum terminale was most common in adults.
- Surgical detethering was performed in 91.66% of children and 100% of adults with acceptable safety profiles.

## Abstract

Background and objective

Tethered cord syndrome (TCS) is an amalgam of neurologic, urologic, orthopedic, and dermatologic dysfunctions with concurrent spinal dysraphism and deformities. Data from Pakistan regarding the surgical management of TCS remain limited. This study aimed to evaluate the clinical and functional outcomes of surgical detethering in patients with TCS and spinal dysraphism.

Materials and methods

This retrospective study was conducted at the Punjab Institute of Neurosciences (PINS), Lahore, Pakistan. We analyzed the outcomes of 21 patients (12 pediatric and nine adults) with TCS who were operated on between January 2020 and June 2025. Patient records were reviewed using the institution’s Picture Archiving and Communication System (PACS), operative notes, and medical charts. Results of the treatment were summarized and analyzed using descriptive statistical analysis.

Results

Among the cohort, 12 patients were pediatric and nine were adults. Pediatric patients had an average age of 4.95 ± 5.03 years and showed a female predominance (66.66%, n = 8). Adults had a mean age of 23.44 ± 8.84 years and also demonstrated a female predominance (66.66%, n = 6). Lower limb weakness was the most frequent presenting symptom, occurring in 50% (n = 6) of children and in a higher proportion of adults at 66.66% (n = 6). Lipomyelomeningocele was the most frequently observed form of spinal dysraphism in children, accounting for 33.33% (n = 4), whereas thickened filum terminale was most common in adults, seen in 33.33% (n = 3). The conus level was most commonly located at L1 in pediatric patients, observed in 50.00% (n = 6), while in adults it was most frequently at L3, occurring in 55.55% (n = 5). Detethering of the spinal cord was the predominant surgical intervention in both pediatric and adult groups, performed in 91.66% (n = 11) of children and 100% (n = 9) of adults. Postoperative assessment showed neurological improvement in 75% (n = 9) of pediatric patients and 55.55% (n = 5) of adults, with no major complications reported in 91.66% (n = 11) of children and 66.66% (n = 6) of adults.

Conclusions

Surgical untethering in patients with TCS leads to improvement in neurological function with an acceptable safety profile, highlighting the importance of early intervention.