Growth of growth hormone-treated and nontreated children before and after tethered spinal cord release

Children with myelomeningocele (MM) are very short and respond to treatment with recombinant human growth hormone (RHGH) with an acceleration in growth. Following primary closure of the MM, a tethered spinal cord may produce neurologic and orthopedic deformities. We compared the short-term growth rate and length standard deviation score (L-SDS) for stature of 13 prepubertal children with MM (7 males, 6 females, mean age 6.1 ± 2.5 years) before and after symptomatic tethered spinal cord release (TCR) to an untreated asymptomatic matched control group. We also compared these data to 7 prepubertal children with MM and growth hormone inadequacy who had TCR and were then treated with RHGH. TCR significantly increased the growth rate compared with matched controls (p < 0.01); however, TCR and RHGH in combination provided an increased gain in growth rate and L-SDS over TCR alone (p < 0.01). Tethered spinal cord influences the growth rate of children with MM. Further study is necessary to evaluate the relationship of the tethered spinal cord to growth and treatment of growth failure.