Complications of Therapies for Tethered Cord Syndrome With a Normally Positioned Conus in Children

Surgical

• Neurological dysfunction: Urinary bladder dysfunction is the most worrisome complication after transection of the filum terminale. To avoid this complication, the filum is transected as distally as possible (e.g., sacral laminectomy) and is put under no tension during surgery.
• Continued preoperative back pain: Continued back pain after postoperative pain has resided should be treated by a pain specialist.
• CSF leak: Postoperative CSF leak is treated with bed rest and a lumbar CSF drain until the operative wound is leak free. This usually lasts several days.
• Wound infection: Superficial wound infections (e.g., nonviolation of the underlying fascia) can be treated with local debridement and antibiotics. Deeper infections require operative opening of the wound with irrigation and debridement.
• Meningitis: If the infection is bacterial, CSF cultures will direct the clinician as to the appropriate antibiotic choice, which is given intravenously in the hospital.