{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:01:17Z","timestamp":1781190077328,"version":"3.54.1"},"reference-count":66,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,10]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Radiological evidence of secondary spinal cord tethering has been observed in patients with myelomeningocele (MMC), even after primary surgical treatment. A significant number of these patients may develop symptomatic tethered cord syndrome (TCS) several times during the clinical course, with worsening of preexisting neurological deficits, or bladder or bowel function. Early untethering is necessary to prevent further progression of symptoms. The aim of this study was to investigate factors influencing postoperative outcome of spinal cord untethering (SCU) on recurrent TCS.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A retrospective analysis was conducted in a cohort of 156 patients with MMC treated between January 1990 and March 2025. Indications for SCU, perioperative data on neurosurgical interventions, postoperative complications, and clinical-neurological outcomes were analyzed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n After primary closure (n = 156), 43% of patients (n = 67) with MMC required at least 1 SCU. A total of 91 SCUs were performed in 67 patients in whom 10 years of follow-up was available. Among those, 30 developed another TCS while 61 remained neurologically stable. After the age of 15 years, the risk of SCU decreased. An increased risk of secondary SCU intervention was found in those individuals with either a postoperative epidural CSF collection (hazard ratio [HR] 3.9, 10-year survival rate; p = 0.02) or a lack of intraoperative neurophysiological monitoring (IONM) used during SCU (HR 2.3, 10-year survival rate; p = 0.03) as negative prognostic factors.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n To achieve timely intervention, it is essential to implement multidisciplinary patient management and early recognition of TCS. Surgical experience is relevant to avoid possible complications with SCU if intervention is indicated. IONM is a valuable technique in the surgical management of secondary TCS as it appears to reduce the risk of repeated surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.9.peds25287","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T02:15:00Z","timestamp":1775873700000},"page":"542-552","source":"Crossref","is-referenced-by-count":0,"title":["Characteristics of repeated untethering pattern in patients with myelomeningocele from infancy to adolescence"],"prefix":"10.3171","volume":"37","author":[{"given":"Joanna","family":"Schneider","sequence":"first","affiliation":[{"name":"Center for Chronically Sick Children, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"},{"name":"Department of Pediatric Neurology, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gesa","family":"Cohrs","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mag\u00edn","family":"de la Flor","sequence":"additional","affiliation":[{"name":"Center for Chronically Sick Children, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"},{"name":"Department of Pediatric Neurology, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Schulz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Wolter","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Finger","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"},{"name":"Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Drenckhahn","sequence":"additional","affiliation":[{"name":"Center for Chronically Sick Children, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"},{"name":"Department of Pediatric Neurology, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela M.","family":"Kaindl","sequence":"additional","affiliation":[{"name":"Center for Chronically Sick Children, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"},{"name":"Section of CNS Development and Neurologic Disease, German Center for Child and Adolescent Health (DZKJ), Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich-Wilhelm","family":"Thomale","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Pediatr Neurosurg","first-page":"243","article-title":"Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord. Presentation, management and outcome","volume":"19","author":"Herman JM","year":"1993","unstructured":"Herman JM, McLone DG, Storrs BB, Dauser RC. Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord. Presentation, management and outcome. Pediatr Neurosurg. 1993;19(5):243\u2013249. doi:10.1159\/000120739"},{"issue":"3","key":"b2","series-title":"Pediatr Neurosurg","first-page":"114","article-title":"Spina bifida outcome: a 25-year prospective","volume":"34","author":"Bowman RM","year":"2001","unstructured":"Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA. Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg. 2001;34(3):114\u2013120. doi:10.1159\/000056005"},{"issue":"4","key":"b3","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Contemporary management and outcome of myelomeningocele: the Rotterdam experience","volume":"47","author":"Spoor JKH","year":"2019","unstructured":"Spoor JKH, Gadjradj PS, Eggink AJ, Contemporary management and outcome of myelomeningocele: the Rotterdam experience. Neurosurg Focus. 2019;47(4):E3. doi:10.3171\/2019.7.FOCUS19447"},{"issue":"4","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"382","article-title":"Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study","volume":"17","author":"Riva-Cambrin J","year":"2016","unstructured":"Riva-Cambrin J, Kestle JRW, Holubkov R, Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr. 2016;17(4):382\u2013390. doi:10.3171\/2015.6.PEDS14670"},{"issue":"3","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"181","article-title":"Tethered cord release: a long-term study in 114 patients","volume":"3","author":"Bowman RM","year":"2009","unstructured":"Bowman RM, Mohan A, Ito J, Seibly JM, McLone DG. Tethered cord release: a long-term study in 114 patients. J Neurosurg Pediatr. 2009;3(3):181\u2013187. doi:10.3171\/2008.12.PEDS0874"},{"issue":"1","key":"b6","series-title":"J Neurosurg","first-page":"116","article-title":"Extensibility of the lumbar and sacral cord. Pathophysiology of the tethered spinal cord in cats","volume":"66","author":"Tani S","year":"1987","unstructured":"Tani S, Yamada S, Knighton RS. Extensibility of the lumbar and sacral cord. Pathophysiology of the tethered spinal cord in cats. J Neurosurg. 1987;66(1):116\u2013123. doi:10.3171\/jns.1987.66.1.0116"},{"issue":"2","key":"b7","series-title":"Neurosurgery","first-page":"214","article-title":"A preliminary report on the use of laser-Doppler flowmetry during tethered spinal cord release","volume":"32","author":"Schneider SJ","year":"1993","unstructured":"Schneider SJ, Rosenthal AD, Greenberg BM, Danto J. A preliminary report on the use of laser-Doppler flowmetry during tethered spinal cord release. Neurosurgery. 1993;32(2):214."},{"issue":"1","key":"b8","series-title":"J Neurosurg Spine","first-page":"79","article-title":"Tethered cord syndrome","volume":"10","author":"Yamada S","year":"2009","unstructured":"Yamada S, Colohan AR, Won DJ. Tethered cord syndrome. J Neurosurg Spine. 2009;10(1):79\u201380. doi:10.3171\/2008.10.SPI15714L"},{"issue":"7","key":"b9","series-title":"Neurol Res","first-page":"722","article-title":"Pathophysiology of tethered cord syndrome and other complex factors","volume":"26","author":"Yamada S","year":"2004","unstructured":"Yamada S, Knerium DS, Mandybur GM, Schultz RL, Yamada BS. Pathophysiology of tethered cord syndrome and other complex factors. Neurol Res. 2004;26(7):722\u2013726. doi:10.1179\/016164104225018027"},{"issue":"2","key":"b10","series-title":"Childs Nerv Syst","first-page":"315","article-title":"Expression profiles of pro-inflammatory and pro-apoptotic mediators in secondary tethered cord syndrome after myelomeningocele repair surgery","volume":"35","author":"Cohrs G","year":"2019","unstructured":"Cohrs G, Drucks B, S\u00fcrie JP, Expression profiles of pro-inflammatory and pro-apoptotic mediators in secondary tethered cord syndrome after myelomeningocele repair surgery. Childs Nerv Syst. 2019;35(2):315\u2013328. doi:10.1007\/s00381-018-3984-6"},{"issue":"2","key":"b11","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Tethered spinal cord following repair of myelomeningocele","volume":"16","author":"Hudgins RJ","year":"2004","unstructured":"Hudgins RJ, Gilreath CL. Tethered spinal cord following repair of myelomeningocele. Neurosurg Focus. 2004;16(2):E7. doi:10.3171\/foc.2004.16.2.8"},{"issue":"3","key":"b12","series-title":"Pediatr Neurosurg","first-page":"236","article-title":"Tethered cord syndrome: an updated review","volume":"43","author":"Lew SM","year":"2007","unstructured":"Lew SM, Kothbauer KF. Tethered cord syndrome: an updated review. Pediatr Neurosurg. 2007;43(3):236\u2013248. doi:10.1159\/000098836"},{"issue":"2","key":"b13","series-title":"Childs Nerv Syst","first-page":"247","article-title":"Intraoperative neurophysiology of the conus medullaris and cauda equina","volume":"26","author":"Kothbauer KF","year":"2010","unstructured":"Kothbauer KF, Deletis V. Intraoperative neurophysiology of the conus medullaris and cauda equina. Childs Nerv Syst. 2010;26(2):247\u2013253. doi:10.1007\/s00381-009-1020-6"},{"issue":"2 Suppl","key":"b14","series-title":"Neurosurgery","first-page":"315","article-title":"The role of intraoperative electromyographic monitoring in lumbosacral lipomas","volume":"56","author":"Valentini LG","year":"2005","unstructured":"Valentini LG, Visintini S, Mendola C, The role of intraoperative electromyographic monitoring in lumbosacral lipomas. Neurosurgery. 2005;56(2 Suppl):315-323. doi:10.1227\/01.neu.0000156783.03809.8a"},{"issue":"9","key":"b15","series-title":"Acta Neurochir (Wien)","first-page":"2087","article-title":"Secondary tethered cord syndrome in adult patients: retethering rates, long-term clinical outcome, and the effect of intraoperative neuromonitoring","volume":"162","author":"Finger T","year":"2020","unstructured":"Finger T, Aigner A, Depperich L, Secondary tethered cord syndrome in adult patients: retethering rates, long-term clinical outcome, and the effect of intraoperative neuromonitoring. Acta Neurochir (Wien). 2020;162(9):2087\u20132096. doi:10.1007\/s00701-020-04464-w"},{"issue":"9","key":"b16","series-title":"Childs Nerv Syst","first-page":"1675","article-title":"Multidisciplinary spina bifida clinic: the Chicago experience","volume":"38","author":"Shlobin NA","year":"2022","unstructured":"Shlobin NA, Yerkes EB, Swaroop VT, Lam S, McLone DG, Bowman RM. Multidisciplinary spina bifida clinic: the Chicago experience. Childs Nerv Syst. 2022;38(9):1675\u20131681. doi:10.1007\/s00381-022-05594-5"},{"issue":"1","key":"b17","series-title":"J Neurosurg Pediatr","first-page":"21","article-title":"Tethered spinal cord among individuals with myelomeningocele: an analysis of the National Spina Bifida Patient Registry","volume":"28","author":"Dias MS","year":"2021","unstructured":"Dias MS, Wang M, Rizk EB, Tethered spinal cord among individuals with myelomeningocele: an analysis of the National Spina Bifida Patient Registry. J Neurosurg Pediatr. 2021;28(1):21\u201327. doi:10.3171\/2020.12.PEDS20868"},{"issue":"9","key":"b18","series-title":"Childs Nerv Syst","first-page":"1611","article-title":"Intraoperative neurophysiology in tethered cord surgery: techniques and results","volume":"29","author":"Sala F","year":"2013","unstructured":"Sala F, Squintani G, Tramontano V, Arcaro C, Faccioli F, Mazza C. Intraoperative neurophysiology in tethered cord surgery: techniques and results. Childs Nerv Syst. 2013;29(9):1611\u20131624. doi:10.1007\/s00381-013-2188-3"},{"issue":"9","key":"b19","series-title":"Childs Nerv Syst","first-page":"1445","article-title":"The value of intraoperative neurophysiological monitoring in tethered cord surgery","volume":"27","author":"Hoving EW","year":"2011","unstructured":"Hoving EW, Haitsma E, Oude Ophuis CM, Journee HL. The value of intraoperative neurophysiological monitoring in tethered cord surgery. Childs Nerv Syst. 2011;27(9):1445\u20131452. doi:10.1007\/s00381-011-1471-4"},{"issue":"1","key":"b20","series-title":"Childs Nerv Syst","first-page":"20","article-title":"Intraoperative neuromonitoring and mapping during spinal cord untethering surgery; a single-centre paediatric neurosurgery unit experience","volume":"41","author":"McDevitt WM","year":"2024","unstructured":"McDevitt WM, Afshari FT, Gallo P, Intraoperative neuromonitoring and mapping during spinal cord untethering surgery; a single-centre paediatric neurosurgery unit experience. Childs Nerv Syst. 2024;41(1):20. doi:10.1007\/s00381-024-06665-5"},{"issue":"5","key":"b21","series-title":"J Spinal Cord Med","first-page":"626","article-title":"Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review","volume":"38","author":"Marreiros H","year":"2015","unstructured":"Marreiros H, Loff C, Calado E. Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review. J Spinal Cord Med. 2015;38(5):626\u2013640. doi:10.1179\/2045772314Y.0000000229"},{"issue":"3","key":"b22","series-title":"Br J Neurosurg","first-page":"253","article-title":"Evaluation of surgery for the tethered cord syndrome using a new grading system","volume":"10","author":"Kirollos RW","year":"1996","unstructured":"Kirollos RW, Van Hille PT. Evaluation of surgery for the tethered cord syndrome using a new grading system. Br J Neurosurg. 1996;10(3):253\u2013260. doi:10.1080\/02688699650040106"},{"issue":"5","key":"b23","series-title":"J Neurosurg Pediatr","first-page":"607","article-title":"Perioperative complications and secondary retethering after pediatric tethered cord release surgery","volume":"32","author":"Pan J","year":"2023","unstructured":"Pan J, Boop SH, Barber JK, Perioperative complications and secondary retethering after pediatric tethered cord release surgery. J Neurosurg Pediatr. 2023;32(5):607\u2013616. doi:10.3171\/2023.6.PEDS23259"},{"issue":"5","key":"b24","series-title":"Neurosurgery","first-page":"989","article-title":"Natural history of tethered cord in patients with meningomyelocele","volume":"50","author":"Phuong LK","year":"2002","unstructured":"Phuong LK, Schoeberl KA, Raffel C. Natural history of tethered cord in patients with meningomyelocele. Neurosurgery. 2002;50(5):989\u2013995."},{"issue":"1","key":"b25","series-title":"J Neurosurg Pediatr","first-page":"28","article-title":"The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome","volume":"4","author":"Al-Holou WN","year":"2009","unstructured":"Al-Holou WN, Muraszko KM, Garton HJ, Buchman SR, Maher CO. The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome. J Neurosurg Pediatr. 2009;4(1):28\u201336. doi:10.3171\/2009.2.PEDS08339"},{"issue":"3","key":"b26","series-title":"J Neurosurg Pediatr","first-page":"269","article-title":"The incidence and effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele: a population-based study","volume":"26","author":"Borgstedt-Bakke JH","year":"2020","unstructured":"Borgstedt-Bakke JH, Wichmann TO, Gudmundsdottir G, Rasmussen MM. The incidence and effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele: a population-based study. J Neurosurg Pediatr. 2020;26(3):269\u2013274. doi:10.3171\/2020.4.PEDS19722"},{"issue":"6 Suppl","key":"b27","series-title":"J Neurosurg","first-page":"434","article-title":"Outcome following multiple repeated spinal cord untethering operations","volume":"106","author":"Maher CO","year":"2007","unstructured":"Maher CO, Goumnerova L, Madsen JR, Proctor M, Scott RM. Outcome following multiple repeated spinal cord untethering operations. J Neurosurg. 2007;106(6 Suppl):434-438. doi:10.3171\/ped.2007.106.6.434"},{"issue":"5","key":"b28","series-title":"J Neurosurg Pediatr","first-page":"498","article-title":"Spinal cord tethering following myelomeningocele repair","volume":"6","author":"Mehta VA","year":"2010","unstructured":"Mehta VA, Bettegowda C, Ahmadi SA, Spinal cord tethering following myelomeningocele repair. J Neurosurg Pediatr. 2010;6(5):498\u2013505. doi:10.3171\/2010.8.PEDS09491"},{"issue":"3","key":"b29","series-title":"J Spine Surg","first-page":"337","article-title":"Pediatric tethered cord release: an epidemiological and postoperative complication analysis","volume":"5","author":"Bhimani AD","year":"2019","unstructured":"Bhimani AD, Selner AN, Patel JB, Pediatric tethered cord release: an epidemiological and postoperative complication analysis. J Spine Surg. 2019;5(3):337\u2013350. doi:10.21037\/jss.2019.09.02"},{"issue":"10","key":"b30","series-title":"Childs Nerv Syst","first-page":"2829","article-title":"Myelomeningocele: the evolution of care over the last 50 years","volume":"39","author":"Bowman RM","year":"2023","unstructured":"Bowman RM, Lee JY, Yang J, Kim KH, Wang KC. Myelomeningocele: the evolution of care over the last 50 years. Childs Nerv Syst. 2023;39(10):2829\u20132845. doi:10.1007\/s00381-023-06057-1"},{"issue":"1","key":"b31","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Electrophysiologically guided untethering of secondary tethered spinal cord syndrome","volume":"29","author":"Pouratian N","year":"2010","unstructured":"Pouratian N, Elias WJ, Jane JA Jr, Phillips LH II, Jane JA Sr. Electrophysiologically guided untethering of secondary tethered spinal cord syndrome. Neurosurg Focus. 2010;29(1):E3. doi:10.3171\/2010.3.FOCUS09299"},{"issue":"6","key":"b32","series-title":"Childs Nerv Syst","first-page":"979","article-title":"Surgical treatment of tethered cord syndrome-comparing the results of surgeries with and without electrophysiological monitoring","volume":"35","author":"Fekete G","year":"2019","unstructured":"Fekete G, Bogn\u00e1r L, Nov\u00e1k L. Surgical treatment of tethered cord syndrome-comparing the results of surgeries with and without electrophysiological monitoring. Childs Nerv Syst. 2019;35(6):979\u2013984. doi:10.1007\/s00381-019-04129-9"},{"issue":"11","key":"b33","series-title":"Childs Nerv Syst","first-page":"1985","article-title":"Long-term evaluation of intraoperative neurophysiological monitoring-assisted tethered cord surgery","volume":"33","author":"Dulfer SE","year":"2017","unstructured":"Dulfer SE, Drost G, Lange F, Journee HL, Wapstra FH, Hoving EW. Long-term evaluation of intraoperative neurophysiological monitoring-assisted tethered cord surgery. Childs Nerv Syst. 2017;33(11):1985\u20131995. doi:10.1007\/s00381-017-3478-y"},{"issue":"5","key":"b1","series-title":"Pediatr Neurosurg","first-page":"243","article-title":"Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord. Presentation, management and outcome","volume":"19","author":"Herman JM","year":"1993","unstructured":"Herman JM, McLone DG, Storrs BB, Dauser RC. Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord. Presentation, management and outcome. Pediatr Neurosurg. 1993;19(5):243\u2013249. doi:10.1159\/000120739"},{"issue":"3","key":"b2","series-title":"Pediatr Neurosurg","first-page":"114","article-title":"Spina bifida outcome: a 25-year prospective","volume":"34","author":"Bowman RM","year":"2001","unstructured":"Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA. Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg. 2001;34(3):114\u2013120. doi:10.1159\/000056005"},{"issue":"4","key":"b3","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Contemporary management and outcome of myelomeningocele: the Rotterdam experience","volume":"47","author":"Spoor JKH","year":"2019","unstructured":"Spoor JKH, Gadjradj PS, Eggink AJ, Contemporary management and outcome of myelomeningocele: the Rotterdam experience. Neurosurg Focus. 2019;47(4):E3. doi:10.3171\/2019.7.FOCUS19447"},{"issue":"4","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"382","article-title":"Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study","volume":"17","author":"Riva-Cambrin J","year":"2016","unstructured":"Riva-Cambrin J, Kestle JRW, Holubkov R, Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr. 2016;17(4):382\u2013390. doi:10.3171\/2015.6.PEDS14670"},{"issue":"3","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"181","article-title":"Tethered cord release: a long-term study in 114 patients","volume":"3","author":"Bowman RM","year":"2009","unstructured":"Bowman RM, Mohan A, Ito J, Seibly JM, McLone DG. Tethered cord release: a long-term study in 114 patients. J Neurosurg Pediatr. 2009;3(3):181\u2013187. doi:10.3171\/2008.12.PEDS0874"},{"issue":"1","key":"b6","series-title":"J Neurosurg","first-page":"116","article-title":"Extensibility of the lumbar and sacral cord. Pathophysiology of the tethered spinal cord in cats","volume":"66","author":"Tani S","year":"1987","unstructured":"Tani S, Yamada S, Knighton RS. Extensibility of the lumbar and sacral cord. Pathophysiology of the tethered spinal cord in cats. J Neurosurg. 1987;66(1):116\u2013123. doi:10.3171\/jns.1987.66.1.0116"},{"issue":"2","key":"b7","series-title":"Neurosurgery","first-page":"214","article-title":"A preliminary report on the use of laser-Doppler flowmetry during tethered spinal cord release","volume":"32","author":"Schneider SJ","year":"1993","unstructured":"Schneider SJ, Rosenthal AD, Greenberg BM, Danto J. A preliminary report on the use of laser-Doppler flowmetry during tethered spinal cord release. Neurosurgery. 1993;32(2):214."},{"issue":"1","key":"b8","series-title":"J Neurosurg Spine","first-page":"79","article-title":"Tethered cord syndrome","volume":"10","author":"Yamada S","year":"2009","unstructured":"Yamada S, Colohan AR, Won DJ. Tethered cord syndrome. J Neurosurg Spine. 2009;10(1):79\u201380. doi:10.3171\/2008.10.SPI15714L"},{"issue":"7","key":"b9","series-title":"Neurol Res","first-page":"722","article-title":"Pathophysiology of tethered cord syndrome and other complex factors","volume":"26","author":"Yamada S","year":"2004","unstructured":"Yamada S, Knerium DS, Mandybur GM, Schultz RL, Yamada BS. Pathophysiology of tethered cord syndrome and other complex factors. Neurol Res. 2004;26(7):722\u2013726. doi:10.1179\/016164104225018027"},{"issue":"2","key":"b10","series-title":"Childs Nerv Syst","first-page":"315","article-title":"Expression profiles of pro-inflammatory and pro-apoptotic mediators in secondary tethered cord syndrome after myelomeningocele repair surgery","volume":"35","author":"Cohrs G","year":"2019","unstructured":"Cohrs G, Drucks B, S\u00fcrie JP, Expression profiles of pro-inflammatory and pro-apoptotic mediators in secondary tethered cord syndrome after myelomeningocele repair surgery. Childs Nerv Syst. 2019;35(2):315\u2013328. doi:10.1007\/s00381-018-3984-6"},{"issue":"2","key":"b11","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Tethered spinal cord following repair of myelomeningocele","volume":"16","author":"Hudgins RJ","year":"2004","unstructured":"Hudgins RJ, Gilreath CL. Tethered spinal cord following repair of myelomeningocele. Neurosurg Focus. 2004;16(2):E7. doi:10.3171\/foc.2004.16.2.8"},{"issue":"3","key":"b12","series-title":"Pediatr Neurosurg","first-page":"236","article-title":"Tethered cord syndrome: an updated review","volume":"43","author":"Lew SM","year":"2007","unstructured":"Lew SM, Kothbauer KF. Tethered cord syndrome: an updated review. Pediatr Neurosurg. 2007;43(3):236\u2013248. doi:10.1159\/000098836"},{"issue":"2","key":"b13","series-title":"Childs Nerv Syst","first-page":"247","article-title":"Intraoperative neurophysiology of the conus medullaris and cauda equina","volume":"26","author":"Kothbauer KF","year":"2010","unstructured":"Kothbauer KF, Deletis V. Intraoperative neurophysiology of the conus medullaris and cauda equina. Childs Nerv Syst. 2010;26(2):247\u2013253. doi:10.1007\/s00381-009-1020-6"},{"issue":"2 Suppl","key":"b14","series-title":"Neurosurgery","first-page":"315","article-title":"The role of intraoperative electromyographic monitoring in lumbosacral lipomas","volume":"56","author":"Valentini LG","year":"2005","unstructured":"Valentini LG, Visintini S, Mendola C, The role of intraoperative electromyographic monitoring in lumbosacral lipomas. Neurosurgery. 2005;56(2 Suppl):315-323. doi:10.1227\/01.neu.0000156783.03809.8a"},{"issue":"9","key":"b15","series-title":"Acta Neurochir (Wien)","first-page":"2087","article-title":"Secondary tethered cord syndrome in adult patients: retethering rates, long-term clinical outcome, and the effect of intraoperative neuromonitoring","volume":"162","author":"Finger T","year":"2020","unstructured":"Finger T, Aigner A, Depperich L, Secondary tethered cord syndrome in adult patients: retethering rates, long-term clinical outcome, and the effect of intraoperative neuromonitoring. Acta Neurochir (Wien). 2020;162(9):2087\u20132096. doi:10.1007\/s00701-020-04464-w"},{"issue":"9","key":"b16","series-title":"Childs Nerv Syst","first-page":"1675","article-title":"Multidisciplinary spina bifida clinic: the Chicago experience","volume":"38","author":"Shlobin NA","year":"2022","unstructured":"Shlobin NA, Yerkes EB, Swaroop VT, Lam S, McLone DG, Bowman RM. Multidisciplinary spina bifida clinic: the Chicago experience. Childs Nerv Syst. 2022;38(9):1675\u20131681. doi:10.1007\/s00381-022-05594-5"},{"issue":"1","key":"b17","series-title":"J Neurosurg Pediatr","first-page":"21","article-title":"Tethered spinal cord among individuals with myelomeningocele: an analysis of the National Spina Bifida Patient Registry","volume":"28","author":"Dias MS","year":"2021","unstructured":"Dias MS, Wang M, Rizk EB, Tethered spinal cord among individuals with myelomeningocele: an analysis of the National Spina Bifida Patient Registry. J Neurosurg Pediatr. 2021;28(1):21\u201327. doi:10.3171\/2020.12.PEDS20868"},{"issue":"9","key":"b18","series-title":"Childs Nerv Syst","first-page":"1611","article-title":"Intraoperative neurophysiology in tethered cord surgery: techniques and results","volume":"29","author":"Sala F","year":"2013","unstructured":"Sala F, Squintani G, Tramontano V, Arcaro C, Faccioli F, Mazza C. Intraoperative neurophysiology in tethered cord surgery: techniques and results. Childs Nerv Syst. 2013;29(9):1611\u20131624. doi:10.1007\/s00381-013-2188-3"},{"issue":"9","key":"b19","series-title":"Childs Nerv Syst","first-page":"1445","article-title":"The value of intraoperative neurophysiological monitoring in tethered cord surgery","volume":"27","author":"Hoving EW","year":"2011","unstructured":"Hoving EW, Haitsma E, Oude Ophuis CM, Journee HL. The value of intraoperative neurophysiological monitoring in tethered cord surgery. Childs Nerv Syst. 2011;27(9):1445\u20131452. doi:10.1007\/s00381-011-1471-4"},{"issue":"1","key":"b20","series-title":"Childs Nerv Syst","first-page":"20","article-title":"Intraoperative neuromonitoring and mapping during spinal cord untethering surgery; a single-centre paediatric neurosurgery unit experience","volume":"41","author":"McDevitt WM","year":"2024","unstructured":"McDevitt WM, Afshari FT, Gallo P, Intraoperative neuromonitoring and mapping during spinal cord untethering surgery; a single-centre paediatric neurosurgery unit experience. Childs Nerv Syst. 2024;41(1):20. doi:10.1007\/s00381-024-06665-5"},{"issue":"5","key":"b21","series-title":"J Spinal Cord Med","first-page":"626","article-title":"Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review","volume":"38","author":"Marreiros H","year":"2015","unstructured":"Marreiros H, Loff C, Calado E. Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review. J Spinal Cord Med. 2015;38(5):626\u2013640. doi:10.1179\/2045772314Y.0000000229"},{"issue":"3","key":"b22","series-title":"Br J Neurosurg","first-page":"253","article-title":"Evaluation of surgery for the tethered cord syndrome using a new grading system","volume":"10","author":"Kirollos RW","year":"1996","unstructured":"Kirollos RW, Van Hille PT. Evaluation of surgery for the tethered cord syndrome using a new grading system. Br J Neurosurg. 1996;10(3):253\u2013260. doi:10.1080\/02688699650040106"},{"issue":"5","key":"b23","series-title":"J Neurosurg Pediatr","first-page":"607","article-title":"Perioperative complications and secondary retethering after pediatric tethered cord release surgery","volume":"32","author":"Pan J","year":"2023","unstructured":"Pan J, Boop SH, Barber JK, Perioperative complications and secondary retethering after pediatric tethered cord release surgery. J Neurosurg Pediatr. 2023;32(5):607\u2013616. doi:10.3171\/2023.6.PEDS23259"},{"issue":"5","key":"b24","series-title":"Neurosurgery","first-page":"989","article-title":"Natural history of tethered cord in patients with meningomyelocele","volume":"50","author":"Phuong LK","year":"2002","unstructured":"Phuong LK, Schoeberl KA, Raffel C. Natural history of tethered cord in patients with meningomyelocele. Neurosurgery. 2002;50(5):989\u2013995."},{"issue":"1","key":"b25","series-title":"J Neurosurg Pediatr","first-page":"28","article-title":"The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome","volume":"4","author":"Al-Holou WN","year":"2009","unstructured":"Al-Holou WN, Muraszko KM, Garton HJ, Buchman SR, Maher CO. The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome. J Neurosurg Pediatr. 2009;4(1):28\u201336. doi:10.3171\/2009.2.PEDS08339"},{"issue":"3","key":"b26","series-title":"J Neurosurg Pediatr","first-page":"269","article-title":"The incidence and effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele: a population-based study","volume":"26","author":"Borgstedt-Bakke JH","year":"2020","unstructured":"Borgstedt-Bakke JH, Wichmann TO, Gudmundsdottir G, Rasmussen MM. The incidence and effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele: a population-based study. J Neurosurg Pediatr. 2020;26(3):269\u2013274. doi:10.3171\/2020.4.PEDS19722"},{"issue":"6 Suppl","key":"b27","series-title":"J Neurosurg","first-page":"434","article-title":"Outcome following multiple repeated spinal cord untethering operations","volume":"106","author":"Maher CO","year":"2007","unstructured":"Maher CO, Goumnerova L, Madsen JR, Proctor M, Scott RM. Outcome following multiple repeated spinal cord untethering operations. J Neurosurg. 2007;106(6 Suppl):434-438. doi:10.3171\/ped.2007.106.6.434"},{"issue":"5","key":"b28","series-title":"J Neurosurg Pediatr","first-page":"498","article-title":"Spinal cord tethering following myelomeningocele repair","volume":"6","author":"Mehta VA","year":"2010","unstructured":"Mehta VA, Bettegowda C, Ahmadi SA, Spinal cord tethering following myelomeningocele repair. J Neurosurg Pediatr. 2010;6(5):498\u2013505. doi:10.3171\/2010.8.PEDS09491"},{"issue":"3","key":"b29","series-title":"J Spine Surg","first-page":"337","article-title":"Pediatric tethered cord release: an epidemiological and postoperative complication analysis","volume":"5","author":"Bhimani AD","year":"2019","unstructured":"Bhimani AD, Selner AN, Patel JB, Pediatric tethered cord release: an epidemiological and postoperative complication analysis. J Spine Surg. 2019;5(3):337\u2013350. doi:10.21037\/jss.2019.09.02"},{"issue":"10","key":"b30","series-title":"Childs Nerv Syst","first-page":"2829","article-title":"Myelomeningocele: the evolution of care over the last 50 years","volume":"39","author":"Bowman RM","year":"2023","unstructured":"Bowman RM, Lee JY, Yang J, Kim KH, Wang KC. Myelomeningocele: the evolution of care over the last 50 years. Childs Nerv Syst. 2023;39(10):2829\u20132845. doi:10.1007\/s00381-023-06057-1"},{"issue":"1","key":"b31","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Electrophysiologically guided untethering of secondary tethered spinal cord syndrome","volume":"29","author":"Pouratian N","year":"2010","unstructured":"Pouratian N, Elias WJ, Jane JA Jr, Phillips LH II, Jane JA Sr. Electrophysiologically guided untethering of secondary tethered spinal cord syndrome. Neurosurg Focus. 2010;29(1):E3. doi:10.3171\/2010.3.FOCUS09299"},{"issue":"6","key":"b32","series-title":"Childs Nerv Syst","first-page":"979","article-title":"Surgical treatment of tethered cord syndrome-comparing the results of surgeries with and without electrophysiological monitoring","volume":"35","author":"Fekete G","year":"2019","unstructured":"Fekete G, Bogn\u00e1r L, Nov\u00e1k L. Surgical treatment of tethered cord syndrome-comparing the results of surgeries with and without electrophysiological monitoring. Childs Nerv Syst. 2019;35(6):979\u2013984. doi:10.1007\/s00381-019-04129-9"},{"issue":"11","key":"b33","series-title":"Childs Nerv Syst","first-page":"1985","article-title":"Long-term evaluation of intraoperative neurophysiological monitoring-assisted tethered cord surgery","volume":"33","author":"Dulfer SE","year":"2017","unstructured":"Dulfer SE, Drost G, Lange F, Journee HL, Wapstra FH, Hoving EW. Long-term evaluation of intraoperative neurophysiological monitoring-assisted tethered cord surgery. Childs Nerv Syst. 2017;33(11):1985\u20131995. doi:10.1007\/s00381-017-3478-y"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/37\/6\/article-p542.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/37\/6\/article-p542.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/37\/6\/article-p542.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:18:41Z","timestamp":1781187521000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/37\/6\/article-p542.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":66,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.9.peds25287","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]}}}