{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T15:23:43Z","timestamp":1773415423200,"version":"3.50.1"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The nature of the relationship between spinal cord syrinx and tethered cord is not well known. It is unclear if surgical cord untethering results in resolution or improvement of an associated syrinx. The objective of this study was to report the response of spinal cord syrinx to surgical cord untethering.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors retrospectively reviewed all patients with a syrinx and tethered cord who presented to a single institution over an 11-year interval. Patients with open neural tube defects were excluded. Thirty-one patients were identified, 25 of whom had both clinical and imaging follow-up after surgery. Patients were grouped according to etiology of the tethered cord. Clinical outcomes and syrinx characteristics were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Of the 25 patients with tethered cord, 68% (n = 17) were male. The average age at presentation was 2.5 years (0\u201310.1 years) and age at surgery was 3.7 years (range 1 day to 17 years). Etiologies of tethered cord were lipomyelomeningocele (n = 8), thickened\/fatty filum (n = 7), intradural lipoma (n = 5), myelocystocele (n = 2), meningocele (n = 2), and diastematomyelia (n = 1). Twenty-three of the patients underwent primary untethering, whereas 2 patients had received untethering previously at another institution. The average syrinx length and width prior to surgery were 4.81 vertebral levels (SD 4.35) and 5.19 mm (SD 2.55 mm), respectively. Conus level ranged from L1 to S3. Patients were followed for an average of 8.4 years (1.35\u201315.85 years). Overall there was no significant change in syrinx length or width postoperatively; the average syrinx length increased by 0.86 vertebral levels (SD 4.36) and width decreased by 0.72 mm (SD 2.94 mm). Seven of 25 patients had improvement in at least one presenting symptom, including scoliosis, weakness, bowel\/bladder dysfunction, and pain. Eight patients had stable presenting symptoms. Six patients were asymptomatic and 5 patients had new or worsening symptoms, which included scoliosis, pain, or sensory changes.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Although some syrinxes improved after surgery for tethered cord, radiological improvement was not consistent and did not appear to be associated with change in clinical symptoms. The decision to surgically untether a cord should be focused on the clinical symptoms and not the presence of a syrinx alone. Further studies are needed to confirm this finding.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.9.peds1944","type":"journal-article","created":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T22:01:34Z","timestamp":1580508094000},"page":"319-325","source":"Crossref","is-referenced-by-count":8,"title":["Syringomyelia in children with closed spinal dysraphism: long-term outcomes after surgical intervention"],"prefix":"10.3171","volume":"25","author":[{"given":"Amy K.","family":"Bruzek","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Starr","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugh J. L.","family":"Garton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin M.","family":"Muraszko","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cormac O.","family":"Maher","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer M.","family":"Strahle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2327","DOI":"10.1097\/BRS.0b013e3181557989","article-title":"The outcomes of scoliosis surgery in patients with syringomyelia","volume":"32","author":"Bradley LJ","year":"2007","unstructured":"Bradley LJ, Ratahi ED, Crawford HA, Barnes MJ: The outcomes of scoliosis surgery in patients with syringomyelia. Spine (Phila Pa 1976) 32:2327\u20132333, 200710.1097\/BRS.0b013e3181557989"},{"key":"b2","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.3171\/2013.2.JNS12759","article-title":"Changes in temporal flow characteristics of CSF in Chiari malformation Type I with and without syringomyelia: implications for theory of syrinx development","volume":"118","author":"Clarke EC","year":"2013","unstructured":"Clarke EC, Stoodley MA, Bilston LE: Changes in temporal flow characteristics of CSF in Chiari malformation Type I with and without syringomyelia: implications for theory of syrinx development. J Neurosurg 118:1135\u20131140, 20132349587810.3171\/2013.2.JNS12759"},{"key":"b3","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1097\/00006123-199912000-00018","article-title":"Terminal syringomyelia in association with the tethered cord syndrome","volume":"45","author":"Erkan K","year":"1999","unstructured":"Erkan K, Unal F, Kiris T: Terminal syringomyelia in association with the tethered cord syndrome. Neurosurgery 45:1351\u20131360, 19991059870310.1097\/00006123-199912000-00018"},{"key":"b4","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1007\/s00381-006-0205-5","article-title":"Diastematomyelia in children: treatment outcome and natural history of associated syringomyelia","volume":"23","author":"Gan YC","year":"2007","unstructured":"Gan YC, Sgouros S, Walsh AR, Hockley AD: Diastematomyelia in children: treatment outcome and natural history of associated syringomyelia. Childs Nerv Syst 23:515\u2013519, 20071702888010.1007\/s00381-006-0205-5"},{"key":"b5","series-title":"Acta Neuropathol Commun","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s40478-014-0091-0","article-title":"Fetal syringomyelia","volume":"2","author":"Guo A","year":"2014","unstructured":"Guo A, Chitayat D, Blaser S, Keating S, Shannon P: Fetal syringomyelia. Acta Neuropathol Commun 2:91, 201410.1186\/s40478-014-0091-025092126"},{"key":"b6","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"553","DOI":"10.3171\/jns.1999.91.4.0553","article-title":"Elucidating the pathophysiology of syringomyelia","volume":"91","author":"Heiss JD","year":"1999","unstructured":"Heiss JD, Patronas N, DeVroom HL, Shawker T, Ennis R, Kammerer W, : Elucidating the pathophysiology of syringomyelia. J Neurosurg 91:553\u2013562, 19991050737410.3171\/jns.1999.91.4.0553"},{"key":"b7","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"513","DOI":"10.3171\/jns.1994.81.4.0513","article-title":"Terminal syringohydromyelia and occult spinal dysraphism","volume":"81","author":"Iskandar BJ","year":"1994","unstructured":"Iskandar BJ, Oakes WJ, McLaughlin C, Osumi AK, Tien RD: Terminal syringohydromyelia and occult spinal dysraphism. J Neurosurg 81:513\u2013519, 199410.3171\/jns.1994.81.4.05137931583"},{"key":"b8","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"307","DOI":"10.3171\/2012.11.PEDS12251","article-title":"Radiographic and clinical outcome of syringomyelia in patients treated for tethered cord syndrome without other significant imaging abnormalities","volume":"11","author":"Kulwin CG","year":"2013","unstructured":"Kulwin CG, Patel NB, Ackerman LL, Smith JL, Boaz JC, Fulkerson DH: Radiographic and clinical outcome of syringomyelia in patients treated for tethered cord syndrome without other significant imaging abnormalities. J Neurosurg Pediatr 11:307\u2013312, 20132325954810.3171\/2012.11.PEDS12251"},{"key":"b9","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1227\/NEU.0b013e31824cebc6","article-title":"Preuntethering and postuntethering courses of syringomyelia associated with tethered spinal cord","volume":"71","author":"Lee JY","year":"2012","unstructured":"Lee JY, Phi JH, Cheon JE, Kim SK, Kim IO, Cho BK, : Preuntethering and postuntethering courses of syringomyelia associated with tethered spinal cord. Neurosurgery 71:23\u201329, 20122270571810.1227\/NEU.0b013e31824cebc6"},{"key":"b10","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"30","DOI":"10.3171\/2010.10.PEDS1057","article-title":"Idiopathic syrinx in the pediatric population: a combined center experience","volume":"7","author":"Magge SN","year":"2011","unstructured":"Magge SN, Smyth MD, Governale LS, Goumnerova L, Madsen J, Munro B, : Idiopathic syrinx in the pediatric population: a combined center experience. J Neurosurg Pediatr 7:30\u201336, 201110.3171\/2010.10.PEDS105721194284"},{"key":"b11","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3171\/jns.1994.80.1.0003","article-title":"Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment","volume":"80","author":"Oldfield EH","year":"1994","unstructured":"Oldfield EH, Muraszko K, Shawker TH, Patronas NJ: Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 80:3\u201315, 199410.3171\/jns.1994.80.1.00038271018"},{"key":"b12","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"430","DOI":"10.3171\/2011.8.PEDS10427","article-title":"Treatment practices for Chiari malformation type I with syringomyelia: results of a survey of the American Society of Pediatric Neurosurgeons","volume":"8","author":"Rocque BG","year":"2011","unstructured":"Rocque BG, George TM, Kestle J, Iskandar BJ: Treatment practices for Chiari malformation type I with syringomyelia: results of a survey of the American Society of Pediatric Neurosurgeons. J Neurosurg Pediatr 8:430\u2013437, 201110.3171\/2011.8.PEDS1042722044364"},{"issue":"6","key":"b13","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E13","DOI":"10.3171\/2011.9.FOCUS11208","article-title":"Natural history of untreated syringomyelia in pediatric patients","volume":"31","author":"Singhal A","year":"2011","unstructured":"Singhal A, Bowen-Roberts T, Steinbok P, Cochrane D, Byrne AT, Kerr JM: Natural history of untreated syringomyelia in pediatric patients. Neurosurg Focus 31(6):E13, 201110.3171\/2011.9.FOCUS1120822133172"},{"key":"b14","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"21","DOI":"10.3171\/2014.12.PEDS14463","article-title":"Syrinx location and size according to etiology: identification of Chiari-associated syrinx","volume":"16","author":"Strahle J","year":"2015","unstructured":"Strahle J, Muraszko KM, Garton HJ, Smith BW, Starr J, Kapurch JR II, : Syrinx location and size according to etiology: identification of Chiari-associated syrinx. J Neurosurg Pediatr 16:21\u201329, 20152583788810.3171\/2014.12.PEDS14463"},{"key":"b15","series-title":"J Bone Joint Surg Br","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1302\/0301-620X.83B3.0830371","article-title":"Natural history of scoliosis in children with syringomyelia","volume":"83","author":"Tokunaga M","year":"2001","unstructured":"Tokunaga M, Minami S, Isobe K, Moriya H, Kitahara H, Nakata Y: Natural history of scoliosis in children with syringomyelia. J Bone Joint Surg Br 83:371\u2013376, 200110.1302\/0301-620X.83B3.083037111341422"},{"key":"b16","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1097\/01241398-199409000-00005","article-title":"Syringomyelia and developmental scoliosis","volume":"14","author":"Tomlinson RJ Jr","year":"1994","unstructured":"Tomlinson RJ Jr, Wolfe MW, Nadall JM, Bennett JT, MacEwen GD: Syringomyelia and developmental scoliosis. J Pediatr Orthop 14:580\u2013585, 199410.1097\/01241398-199409000-000057962497"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/25\/3\/article-p319.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/25\/3\/article-p319.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/25\/3\/article-p319.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T20:00:49Z","timestamp":1681588849000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/25\/3\/article-p319.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":16,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2019.9.peds1944","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3]]}}}