Risks and Realities of Tethered Cord Surgery: What Patients Should Know
While tethered cord surgery carries potential risks, the long-term benefits for patients often far outweigh the possible complications. This neurosurgical procedure is designed to prevent progressive neurological deterioration in individuals with tethered spinal cords, especially when symptoms such as bladder dysfunction, leg weakness, or back pain are present. With advances in surgical techniques and intraoperative monitoring, modern medicine has significantly improved patient outcomes and reduced the likelihood of severe adverse events.
Understanding the Primary Risks of Surgery
One of the most significant concerns associated with tethered cord release is the potential impact on bladder and bowel function. The lower spinal cord contains critical nerve pathways that regulate urinary and fecal control, and these nerves can be vulnerable during surgical intervention. In rare cases, inadvertent damage to these neural structures—particularly if they are intertwined with the filum terminale—can result in permanent dysfunction. This type of injury typically occurs when non-distinguishable "pass-through" nerves are mistakenly severed during the untethering process without proper identification.
The Role of Intraoperative Monitoring in Risk Reduction
Today's advanced surgical protocols have dramatically minimized this risk through the use of intraoperative neurophysiological monitoring (IOM). Surgeons now routinely employ electrical stimulation techniques to test neural responses before cutting the filum terminale. By stimulating nearby tissue and observing real-time feedback from motor and sensory nerves, medical teams can differentiate between inert fibrous bands and functional nerve fibers. This precision allows for safer dissection and greatly reduces the chance of postoperative voiding or bowel disorders.
Safety Profile Based on Case Complexity
Cases involving a simple thickened filum terminale are generally considered low-risk procedures with high success rates and minimal complications. These straightforward interventions often involve limited dissection and carry a favorable recovery outlook, especially in pediatric patients. However, more complex forms of tethered cord syndrome—such as those associated with intraspinal tumors, prior surgeries, or extensive scar tissue—present greater surgical challenges.
Challenges in Complex Cases: Tumors and Repeated Surgeries
When tethering is combined with spinal tumors like lipomas or dermoids, complete resection becomes technically difficult and increases the risk of complications. Attempting full tumor removal may inadvertently damage healthy neural tissue, leading to new neurological deficits. Additionally, repeated operations often result in dense adhesions around the spinal cord, making dissection delicate and time-consuming. In such scenarios, the primary goal shifts from total excision to safe detethering while preserving existing neurological function.
Postoperative Healing Concerns, Especially in Children
Another notable issue following tethered cord surgery involves wound healing, particularly in the sacral region. After release, the dura mater in this area—especially in young children—can become extremely thin and fragile. This anatomical vulnerability increases the risk of cerebrospinal fluid (CSF) leakage and delayed wound closure. Children who lie prone during sleep may place additional pressure on the incision site, contributing to persistent drainage or even wound dehiscence.
To mitigate these risks, surgeons often reinforce the closure with grafts or sealants and recommend strict postoperative positioning guidelines. Close monitoring in the weeks following surgery helps detect early signs of infection or CSF leak, allowing prompt intervention and improving overall recovery outcomes.
In conclusion, while tethered cord surgery does involve certain risks—including potential urological complications, technical difficulties in complex cases, and postoperative wound issues—the integration of modern monitoring technologies and refined surgical approaches has made it a relatively safe and highly beneficial procedure for appropriately selected patients.