History of the Management of Spina Bifida Occulta and Tethered Cord Syndrome in Children

Understanding of Disease

• Occult spinal dysraphism: Occult spinal dysraphism was grouped with other causes by von Recklinghausen in the late 1800s. (4).
• Tight filum: Neurological deterioration due to tight filum was noted by Garceau in the 1950s (2).
• “Tethered cord syndrome”: This term was coined by Hoffman in the 1970s (3).

Technological Development

• Surgical microscope: The advent of the surgical microscope aided in better visualization of the neural elements.
• Microsurgical techniques: The subsequent development of microsurgical techniques enabled smaller incisions.
• MRI: The advent of MRI improved preoperative delineation of the anatomical findings for surgical planning. MRI was first used in the 1980s (1).

Surgical Technique

• Myelomeningocele: The first resection of a meningocele sac was reported by Peter Van Forest in 1610 (1).
• Filar lipomas: The improvement in urinary continence after removal of a filum lipoma was first reported by Bassett in 1950 (12).