Tethered Cord: Post-Operative Care Clinical Pathway

Pathway Background and Objectives

Tethered cord occurs when the spinal cord is attached to tissues around the spine, most commonly at the base of the spine. The attached tissue limits the movement of the spinal cord within the spinal column and causes an abnormal stretching of the spinal cord and impairment of blood flow to the nerve tissue. This syndrome can be closely associated with spina bifida or occur as an independent entity related to disorders of secondary neurulation and some tumors. The lower tip of the spinal cord (conus medullaris) is normally located opposite the disc between the first and second lumbar vertebrae. In individuals with tethered cord, the conus medullaris may be located below the interspace between the second and third lumbar vertebrae, and/or there may be radiographic evidence of abnormal points of attachment (i.e. thickened filum terminale, intraspinal mass, spinal cord adjacent to thecal sack in a fixed position). Standardization of post-operative care for these patients is essential to ensure successful healing.

The specific objectives of the pathway are to:

  • To improve and standardize post-operative care of the patient undergoing tethered cord surgery
  • To eliminate variability and establish a standard of care for these patients

Algorithm  Educational Module

  • Percentage of patients with pathway order set usage
  • Percentage of patients with deep wound infections
  • Percentage of patients with superficial skin infections (SSI)
  • Number of patients with organ space infection within 30 days of principal operative procedure
  • Readmission within 30 days
  • Return to the OR within 30 days
  • Nella Stoltz, APRN
  • Markus Bookland, MD
  • Jonathan Martin, MD

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.