Complications of Spina Bifida Occulta and Tethered Cord Syndrome in Children

Surgical

• CSF leak: If CSF leakage occurs, re-exploration for repair may be required. For persistent leaks, an evaluation for hydrocephalus may be needed. 
• Pseudomeningocele: Pseudomeningocele is the occurrence of a fluid collection under the incision with no signs of infection. It may improve with conservative management. Alternatively, it may require surgical exploration for problematic symptoms such as positional headaches.
• Infection: Superficial wound infection may occur and require opening of part of incision for drainage. Oral antibiotics (gram-positive coverage, but may need to expand coverage depending on circumstances) may be sufficient for these types of superficial infections. Deeper infections may require surgical exploration with wound washouts. These types of infections as well as signs of meningitis such as fevers, headache, and nuchal rigidity may necessitate an infectious disease consultation.
• Bowel or bladder dysfunction: Changes in bowel and bladder function may lead to a need for a GU consultation, physical therapy, and biofeedback. The use of intraoperative monitoring may help prevent bowel or bladder dysfunction.
• Neurological injury involving legs: Changes in lower extremity sensation or strength, while unusual, may be seen.
• Retethering: Overall, there is a 20% incidence of symptomatic retethering after surgery for tethered spinal cords. However, retethering after cutting a filum snip is rare. Surgical re-exploration may be required. CINE MRI or prone MRI to evaluate cord motion should be considered if retethering is suspected.