Tethered cord syndrome: clinical signs and results of operation in 42 patients with spina bifida aperta and occulta.

The results of tethered spinal cord operations in 42 patients were evaluated. Over a period of 10 years, 20 spina bifida occulta (S.B.O.) and 22 spina bifida aperta (S.B.A.) patients were operated. In the S.B.O. group 6 patients were operated when young in order to prevent neurological deterioration. With a mean follow-up of 3 years they developed no new neurological symptoms. The clinical symptoms and the age at which the neurological deterioration occurred was quite similar in the S.B.O. and S.B.A. patients. Motor dysfunction and pain in back and/or legs were the most frequent symptoms. The postoperative complication rate was low. The purpose of surgery was to stop further neurological deterioration. The operative results were slightly better in the S.B.A. group than with the S.B.O. group. In both groups of patients it was evident that operation at an older age after a long period of complaints was associated with less favourable postoperative results. The surgical treatment of a tethered spinal cord syndrome in patients with spina bifida aperta is no more risk than an operation in spina bifida occulta patients.

Progressive neurological deficit in children with spina bifida aperta.

The results of re-operation of 15 patients with spina bifida aperta are reported. The operation was necessary because of neurological deterioration with increasing motor and bladder dysfunction. In all patients a tethered cord syndrome was present (CT-myelography). The myelum was adherent to the scar of the myelomeningocele repair. At operation the myelum is released from the adherent scar and in this way untethered. The early complications were mild except for one patient with decompensation of hydrocephalus. The aim of the operation was to stop further progression. The results of the operation were satisfactory with stabilisation of motor function in four patients and improvement of motor dysfunction in ten patients. Backache or fixation, bladder dysfunction and abnormal foot shape improved in some of the patients. In our experience the operative untethering procedure was useful. Intensive neurological control of operated spina bifida aperta patients is mandatory especially in those patients who can walk.

Results of the treatment of hydrocephalus with ventriculo-jugular shunts.

260 children with hydrocephalus were treated with a ventriculo-jugular shunt. We compared the complication - rate between Holter-shunts and Pudenz-shunts. As far as we could verify 58 children died from several causes. 190 revisions were done in 114 patients, 110 revisions in 71 children with a Holter - valve and 80 revisions in 43 children with a Pudenz - valve. The complication-rate was 112 in 176 Holter - valves and 84 in 84 Pudenz - systems. In our hands the use of the Holtersystem gives better results. As one can conclude from these figures and those from others (Tsingoglou and Forrest 1971), the treatment of children with hydrocephalus is still far from ideal.

Herniated lumbar discs in teenagers.

Forty-three patients under the age of 19 in whom a lumbar disc protrusion was diagnosed and surgically demonstrated are reviewed. The symptomatology resembles that of adults. In 19 cases there was clear relation of trauma to the onset of symptoms. The results of surgical treatment are discussed.