Background: Primary tethering of the spinal cord can result in significant urologic complications including neurogenic bladder and lower urinary tract symptoms. However, there are differing opinions regarding the impact of release of simple tethered cord without open or lipomatous elements on urinary function. We hypothesize that earlier tethered cord release is associated with better urologic outcomes compared to later intervention.Methods: An IRB approved retrospective registry was queried for patients who underwent a laminectomy for a simple tethered cord release (TCR) between 1/1/2013 and 12/31/2023 and who had a post-operative video urodynamic study (VUDS). Patients with complex tethered cord releases (open spinal dysraphisms or lipomas), history of bladder surgeries, previous laminectomies, or additional genitourinary anomalies impacting urologic function were excluded. Associated anomalies were defined as patients having at least two structural congenital defects within the VACTERL spectrum. TCR done in the first year of life was defined as early (ETCR), and those done later were defined as late (LTCR). Associations were tested using the χ2, Fisher’s exact, and Mann-Whitney U tests as appropriate. P-value less than 0.05 was considered statistically significant.Results: A total of 733 patients underwent TCR in the study period, and 89 underwent a post-operative VUDS. 48 (54%) underwent LTCR, and 41 (46%) ETCR (Table 1). Congenital anomalies associated with tethered cord were more frequent in patients released early compared to late (58% vs 25%; p <0.001). Other typically unassociated congenital anomalies were found in 41% and 58% of ETCR and LTCR patients, respectively. The most frequent indication for release differed between groups, with 56% of ETCR patients diagnosed following routine associated anomaly screening compared to 6% of LTCR. Surgical detethering was indicated by bladder/bowel changes in 58% of LTCR compared to 7% of ETCR. The VUDS closest to 6 months after surgical detethering was analyzed for each patient. Pressure at actual bladder capacity was observed to be lower in those with ETCR compared to LTCR (4 vs 6 cmH2O; p = 0.001). ETCR also had a higher percentage of patients with normal bladder compliance (93% vs 73%; p = 0.02). No difference was observed in frequency of uninhibited bladder contractions between ETCR and LTCR (53% vs 41%; p = 0.35). Conclusion: Earlier detection and surgical intervention to treat simple tethered cords is associated with better urologic function following surgical intervention. Early detection and treatment may prevent poor urinary function as assessed by VUDS, however there are still some patients with abnormal results following surgical detethering. Further research is warranted to better understand earlier detection of tethered cords in patients without previously known associated anomalies to preserve urologic function and provide accurate counseling on expectations following TCR and need for post-operative urologic care.
