Surgical treatment of occult spinal dysraphism with tethered spinal cord

ABSTRACT

Occult spinal dysraphism [OSD] consists of a subgroup of spinal dysraphism in which the congenital abnormality of the spinal cord is covered by intact skin and is associated with dermatologic, skeletal, urogenital and/or neurological abnormalities. This study was undertaken to evaluate the early prophylactic effect of surgery on OSD on subsequent expression of neurologic and musculoskeletal abnormalities. Thirty six patients with OSD with tethered cord who underwent surgery for treatment from October 2001 to October 2004 in Department of Neurosurgery of Shiraz University of Medical Sciences affiliated hospitals were evaluated 6 and 12 months postoperatively including a complete history and physical examination with special attention on spinal cord and lower limb function, bladder muscular force, and urodynamic studies. The most frequent dermatologic expression of OSD included hairy patches, subcutaneous lipoma, skin dimple and haemangioma. Scoliosis was observed in 13 cases, among them 7 cases had split cord syndrome, 2 cases had hypertrophic filum terminal [HFT] and 4 cases had both of the conditions. Among those with split cord syndrome, 78.6%, 14.3% and 7.6% were bony, fibrocartilagenous and fibrotic respectively. All patients improved significantly after the procedure. It appears that prophylactic surgical intervention in cases of OSD is a safe and recommended procedure prior to the onset of neurologic deterioration