Intended for healthcare professionals

Clinical Review Lesson of the week

Tethered cord syndrome after myelomeningocoele repair

BMJ 1999; 318 doi: (Published 20 February 1999) Cite this as: BMJ 1999;318:516
  1. N u Owase Jeelani, medical studenta,
  2. Tim Jaspan, consultant neuroradiologistb,
  3. Jonathan A G Punt, paediatric neurosurgeon (
  1. aDepartment of Paediatric Neurosurgery, University Hospital, Nottingham NG7 2UH
  2. bDepartment of Neuroradiology, University Hospital, Nottingham
  1. Correspondence to: Dr Punt Jonathan Punt
  • Accepted 26 June 1998

Secondary tethering of the spinal cord after myelomeningo- coele repair is a remediable complication that requires prompt treatment

Although the incidence of neural tube defects has fallen appreciably in the past two decades, from 3.4/1000 live births and stillbirths in 1974 to 0.8/1000 in 1994, the decline seems to be levelling off.1 The reduction is partly attributable to the increased consumption of folic acid by expectant mothers and partly to improved detection of defects in utero, which has led to the termination of approximately 50% of these pregnancies.2 Current protocols for patient care and management mean that 85% of liveborn infants with neural tube defects are now expected to reach adulthood,3 creating a cohort of people who are vulnerable to certain long term complications. Current healthcare systems need to be aware of this vulnerability, and adequate provision must be made if additional preventable disabilities are to be avoided in these people.

Although specific complications of renal failure, skin breakdown, and shunt malfunction have been highlighted in recent reports,4 the importance of one particular complication—symptomatic secondary tethering of the spinal cord—may have been underemphasised. We report one such case in an adolescent girl who presented with acute deterioration of her neurological status 17 years after surgical closure of her myelomeningocoele.

Case report

A 17 year old girl presented with a constant dull backache and weakness in her legs that made her unable to bear …

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