. 2019 Jul 8;16(4):715–727. doi: 10.14245/ns.1836342.171

Table 2.

Recommendations for screening and care of individuals with spina bifida with tethered cord syndrome

0–11 Months
	^a.	Surgically reapproximate the pial edges of the neural placode (surgical neurulation) and close the wound in sequential layers.
	^b.	Follow infants younger than 12 months in the clinic, at 3- to 4-month intervals.
	^*c.	Orthopedic evaluations are recommended every 3 months in the first year of life.
1–2 Years 11 months
	^a.	Follow children at 6-month intervals for routine care in the Spina Bifida clinic and remain available in the event of clinical change.
	^b.	Teach families the signs of TCS (back pain, declining lower extremity sensorimotor function). Follow the child clinically to observe for these signs. Relevant for all subsequent ages
	^c.	Use adjunctive studies judiciously (imaging such as MRI/CT, urodynamics) during routine well-child visits, according to experience, preference, and best clinical judgment, to augment clinical decision-making. Relevant for all subsequent ages
	^*d.	Monitor the spine for the development or progression of a deformity that may be due to a tethered cord or syrinx. Obtain anteroposterior and lateral scoliosis radiographs if a deformity is suspected on clinical exam. Perform radiographs in a sitting position if the patient is able to sit but not able to stand or in a standing position if the patient can stand. Repeat radiographs every 1 to 2 years if the deformity is present, depending on rate of progression.
	^*e.	Evaluate for neurologic changes or progression of scoliosis and discuss with neurosurgery specialists.
3–5 Years 11 months
	^a.	Follow children at intervals of 6–12 months in the Spina Bifida clinic.
	^*b.	Evaluate the spine clinically and obtain scoliosis radiographs every one to two years if a progressive spinal deformity is suspected.
		Perform radiographs in a sitting position in children who can sit but not stand and in a standing position in children who can stand.
	^*c.	Work with neurosurgery specialists to determine whether a neurogenic cause of scoliosis progression is present.
	^*d.	It is recommended that surgical treatment of scoliosis be reserved for a progressive deformity that is unresponsive to nonoperative management. For example, when there is a progression of scoliosis in spite of bracing and after a neurosurgical cause, such as a tethered cord, it has been ruled out. It is also recommended that management with growing rod surgery and fusionless technique should include spinal cord monitoring in patients with distal neurologic function.
6–12 Years 11 months
	^a.	Follow children aged 6–12 years 11 months at 12-month intervals in the Spina Bifida clinic.
	^*b.	It is recommended that surgical treatment of scoliosis be reserved for a progressive deformity that is unresponsive to non-operative management. An example is when scoliosis has progressed in spite of bracing and after a neurosurgical cause, such as a tethered cord, has been ruled out. It is also recommended that management with growing rod surgery and fusionless technique should include spinal cord monitoring in patients with distal neurologic function. Growing rod surgery with sacral-pelvic fixation is effective in correcting the deformity and achieving growth.
13–17 Years 11 months
	^a.	Follow children ages 13–17 years 11 months at 12-month intervals in a Spina Bifida clinic.
	^*b.	Monitor for the development or progression of scoliosis clinically, with radiographs as necessary, if indicated by the physical exam.
		Perform radiographs in a sitting in a position in those who can sit but not stand and in a standing if position in those who can stand. If the curve has progressed to an operative magnitude (50°), discuss the risks and benefits of surgical treatment with the family.

MRI, magnetic resonance imaging; CT, computed tomography.

Orthopedic surgeon. ^Neurosurgeon.

Adapted from Guidelines for the Care of People with Spina Bifida, Spina Bifida Association; 2018.