Tethered Cord Sindrome nel mielomeningocele: follow up per un timing diagnostico-terapeutico

Objective. Aim oJ the study is to evaluate what symptoms suggest Tethered Cord Syndrome (TCS) in children affected by myelomeningocele (MMC) and what are the diagnostic strategies for a correct surgical timing. Methods. The study consists in a retrospective evaluation of 22 MMC patients' clinical history after surgical spinal detethering, performed between 1991 and 2008. Every patient was monitored according to a clinical-diagnostic protocol used in the Department oJ Pediatrics of the University of Padua. Results. Signs and symptoms suggesting TCS presented Jrequently in this population were: motor (77%), spinal curves variations such as scoliosis (63,6%), Chiari Malformation symptoms (45%), sphinteric (40,9%), urodynamical study changes (50%, in an hali of them without clinical symptoms), sensitive (40,9%). Globally, after surgical detetherig, we observe a worsening in 2 children (9%), while 16 patients improve (73%). Only 4 children (18%) tend to be clinically stable. Conclusions. As in MMC patients life expectancy grows, TCS diagnosis becomes more importantJor the difficulty to detect the subtle and slow neurological and/or sphinterical worsening also in these so compromised patients. We confirm the fundamental rale oJ a multidisciplinary follow up for the prevention and the precocious diagnosis of TCS