Evaluation of surgery for the tethered cord syndrome using a new grading system.

A new grading system is presented to assess the degree of untethering achieved at surgery for the 'tethered cord syndrome' based on intraoperative observation at the end of the procedure. Various pathophysiological mechanisms responsible for the 'tethered cord syndrome', as well as possible factors causing retethering were considered in developing this grading system. In Grade I the cord is considered to be fully untethered and the factors potentially responsible for retethering are eliminated, in Grade II partial untethering is performed and in Grade III untethering is unsuccessful. This grading system was used to assess the results of 22 consecutive operations performed to release a tethered cord between June 1991 and February 1995. The tethering factors encountered at surgery were: spinal lipoma in 14, diastematomyelia in five, a tight filum terminale in 10 and intradural adhesions in three instances. The grade of untethering was correlated with the type of pathology encountered, postoperative results, and whether previous surgery was performed or not. Previous surgery was found not to affect the rate of subsequent successful untethering.