Major or serious complications are uncommon during this surgery. Surgical treatment was indicated for patients with radiologically proven tethering of the spinal cord who consistently showed progressive neurologic deficits, back/lower limb pain, or sphincter dysfunction. 2015-1002-02-09; grant recipient: XK). In addition and preoperatively, there were 68 cases (83%) of varying degrees of pain in the lumbosacral portion and lower extremity, 58 cases (71%) of motor dysfunction of the lower extremity, 44 cases (54%) with abnormal sensation, and 50 cases (61%) of defecation dysfunction. In the case of adult tethered cord not . After untethering surgery, CSF leakage, neurologic deterioration, hematoma, difficult wound healing, and meningitis have been reported (Table 5).1 This condition is Tethered cord syndromea study of the short-term effects of surgical detethering on markers of neuronal injury and electrophysiologic parameters. 19. Tethered cord is usually present at birth . Based on this small retrospective case series, SSO appears to provide clinical improvement at least comparable to that of the untethering procedure, especially in more challenging cases (complex malformations or revision surgery). 5 Sometimes, the spinal cord nerve roots are cut. National Library of Medicine Urologic dysfunction subjectively improved in 36% of the patients with that complaint. In contrast, fusion surgery in SSO might lead to adjacent segment disease that may require subsequent surgery in the long term after SSO. Iskandar B J, Fulmer B B, Hadley M N, Oakes W J. Congenital tethered spinal cord syndrome in adults. . 7 sharing sensitive information, make sure youre on a federal The management of tethered spinal cord syndrome with onset of symptomatology occurring in adulthood remains controversial, although the necessity of early surgery in the pediatric tethered cord syndrome population is well established. This abnormal attachment is associated with progressive stretching and increased tension of the spinal cord as a child ages, potentially resulting in a variety of . The site is secure. Independent sample t tests and Fisher exact tests were performed to compare the results between the untethering and SSO groups. 11. Objective To evaluate the surgical treatment of tethered cord syndrome (TCS), a prospective analysis of 43 patients operated at Neurosurgery Department Zagazig University hospitals from May 2013 to January 2017 with 1 year follow-up had been done. stretching. 10 Six hospitals in our spine group were included. 1999 Jan;90(1):175. doi: 10.3171/jns.1999.90.1.0175. 8 Koji Sato, none In a baby with Spina bifida the spinal cord is still attached to the skin around it preventing it from rising properly. The patient with symptoms following resection of a lipomyelomeningocele: do increases in the lumbosacral angle indicate a tethered spinal cord? Stetler WR Jr, Park P, Sullivan S. Pathophysiology of adult tethered cord syndrome: review of the literature. Pathophysiology of tethered cord syndrome and similar complex disorders. Adults. 5 6 9 Management of adult tethered cord syndrome: our experience and review of literature. Fourteen patients (37.712.5 years) with TCS were enrolled at 6 hospitals. To ascertain the results of surgery in adult patients with this anomaly, the authors undertook a retrospective review of 34 cases. Clipboard, Search History, and several other advanced features are temporarily unavailable. 11 The horizontal sacrum as an indicator of the tethered spinal cord in spina bifida aperta and occulta. 5 Application of microsurgical technique for intraspinal lipoma tethered cord syndrome: report of 611 cases. You may search for similar articles that contain these same keywords or you may Overall, it remains unclear which procedure is preferable for TCS in adults: untethering surgery or SSO. 8 Tethered Cord Syndrome can be difficult to diagnose in babies and children since the symptoms may be subtle and insidious over time. Unable to load your collection due to an error, Unable to load your delegates due to an error. It is often associated with spina bifida and scoliosis. Two groups were distinguished based on the absence (Group A, 43 patients) or presence (Group B, 42 patients) of an associated lipoma or dysraphic cyst (that is, dermoid, epidermoid, or neurenteric cyst). The spinal cord tension was relieved after surgery as shown by preoperative MRI. A. The combined complication rate of this surgery is usually 1-2%. After the tumor was removed, the dura mater spinalis with low tonus was closed by water, and the dura mater spinalis with high tonus was formed by the autogenous fascia. Log in | Become a member | Create an Account If you are unable to log in contact membership@cns.org After surgery, the lipoma was removed almost completely (B). Surg Neurol Int. Equipment. A T12 to L1 diskectomy and L1 upper one-third vertebral body resection were performed thereafter. [10] Of course, if the relief of tethered parts of the cauda equina obtained a relatively satisfactory outcome during the surgery, most occupying lesions and diseased filum terminale were removed, postoperative symptoms improved at different degrees, further recovery of the nerve function could thus be observed in the long-term follow-up period. 6 Fioricet was the first migraine medication I was prescribed. Our team of specialists will be with you from the day of the diagnosis, through surgery and continuing into your child's growth to . Surgery for a Tethered Spinal Cord. The lower half of the T12 lamina, the bilateral lower articular processes at T12, and the bilateral L1 superior articular processes were resected, and the bilateral L1 pedicles and bilateral transverse processes were then removed. He presented with symptoms of lower back pain and legs pain. Federal government websites often end in .gov or .mil. Shiro Imagama, none Note: Results are the number of patients with improvement/the number of patients with each symptom preoperatively. In some children who have tethered cord syndrome, they may lose control of their bladder or bowels. Recovery was mostly seen in infants and only in one older child. The laminae and transverse processes of the vertebrae at T12 and L2 were resected, and the pedicle screws were placed bilaterally at these vertebrae. Rajpal S, Tubbs RS, George T, Oakes WJ, Fuchs HE, Hadley MN, Iskandar BJ. The duration of symptoms was significantly longer in the SSO group (2512.4 years) than in the untethering surgery group (8.26.3 years; p=0.01). In the article, Surgical treatments on adult tethered cord syndrome: A retrospective study, which appeared in Volume 95, Issue 46 of Medicine, a sentence in the abstract, A retrospective analysis of 82 adult patients (17 male cases, 82% and 24 female cases, 59%) appeared incorrectly and should have appeared as A retrospective analysis of 82 adult patients (34 male cases, 41.5% and 48 female cases, 58.5%) In , the totals in the Complete release and Partial release columns appeared incorrectly and should have appeared as seen in the table below. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Depending on the type of tethered cord your child has, they may be more at risk for re-tethering (when the spinal cord reattaches to tissue). The https:// ensures that you are connecting to the Garceau theorized that tension on the . 5 Surgical treatment is the only effective method to relieve occupying, loose adhesions, and compression, its main purpose is to lift the tethered to reduce the stretching of the taper tension, and thus to control further development of symptoms and to reduce further damage to the nerve function. Dermoid cyst and epidermoid cyst caused TCS was observed in 32 cases, with 6 cases indicating improved symptoms, 26 cases showing stabilized symptoms, and no case got worse. Imaging is very important for the diagnosis of tethered cord. The care team uses neurophysiologic intraoperative monitoring during the entire surgery to ensure your childs spinal cord still works properly. Features of the condition may include foot and spinal abnormalities; weakness in the legs; loss of sensation (feeling) in the lower limbs; lower back pain; scoliosis; and urinary incontinence. School-age children are typically out of school for 2 weeks. The General Hospital Corporation. In surgically treated patients, pain relief can often be achieved, and long-term neurological stabilization tends to persist more often than it does in conservatively treated patients. [3,4] Adult onset cases are rare compared to that in children. A representative case of spine-shortening osteotomy. Now, to catluvr's post. Tethered cord means that the spinal cord movement is limited within the spinal column due to abnormal tissue attachments. 11 Miyakoshi et al reported complete clinical recovery without complications in 2009, which led to the hope that SSO would be the way to reduce perioperative complications and provide better neurologic outcomes.10 Although Kokubun et al also reported good clinical results after SSO in 2011,11 there have been no reports until now of a comparative study or review of these two procedures. Physicians: To refer a patient, call 410-955-7337. Among individuals who did not undergo surgery, 17 patients refused surgery and 25 patients underwent recommended conservative treatment. A tethered spinal cord occurs when the spinal cord is attached to tissue around the spine, most commonly at the base of the spine. Tethered cord syndrome: an updated review. Tethered cord syndrome (TCS) refers to a series of neurological dysfunction caused by the retraction of the conus medullaris related to a variety of reasons, which is manifested by both lower extremities orbicularis weakness, sensory abnormalities, defecation dysfunction, and so on.[1]. This can lead to infection if the incision is on the low back. 4 This may take a few attempts, so it is important to not become discouraged after their first try. Shukla M, Sardhara J, Sahu RN, Sharma P, Behari S, Jaiswal AK, Srivastava AK, Mehrotra A, Das KK, Bhaisora KS. An official website of the United States government. The authors prefer to limit bathing to a sponge bath until the patient is seen in clinic 1 week later. Tethered Cord Syndrome (TCS) is a broad term that encompasses both congenital (primary) and acquired (secondary) pathologies that anchor, elongate and tension the spinal cord[1] The spinal cord fixation produces mechanical stretch, distortion, and ischemia with daily activities, growth, and development[2] This prevents the spinal cord from freely moving, which then increases . 8600 Rockville Pike Pain or anti-inflammatory medication. SSO was performed at the level of T12 or L1 (Fig. PMC Your childs urinary catheter will be removed. Thoracolumbar surgery for degenerative spine diseases complicated with tethered cord syndrome: A case report. Of 40 cases without occupying lesions of tethered spinal cord, the symptoms were improved in 14 cases. WebSurgery is a treatment option for tethered spinal cord syndrome; however, to relieve pain if surgery is not advisable, the spinal cord nerve roots may be cut. Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. WebWhat happens after tethered spinal cord surgery? 15. The mean duration of follow-up was 4.73.5 years (range, 2.0 to 15.5 years). Tethered cord, also called tethered spinal cord syndrome, occurs when the spinal cord abnormally attaches to tissue inside the spinal canal, usually at the base of the spine. Throughout the entire surgery, the care team will check how your childs spinal cord is working properly. Neurosurgeons have long performed procedures that inadvertently shorten the spinal column, such as partially or fully removing vertebrae when a cancerous tumor arises within the bone. However, his condition subsequently deteriorated, and he could not walk by himself 1year after untethering surgery. Changes of symptoms were associated with the course of disease; patients with relatively shorter disease course were shown to have a mild Hoffman grading, whereas patients with relatively longer disease course were indicated to have a severe Hoffman grading. A hairy patch overlying the spine in any area is almost always associated with an underlying splitting of the spinal cord by a band of fibrous tissue or bone (a diastematomyelia). Neurosurg Focus. As first-line treatment, patients presenting with TCS typically undergo direct spinal cord untethering, often as young children or infants. Depending on your childs age, symptoms of tethered cord syndrome vary. Second, a standardized surgical protocol was not used, and the surgical approach was left to the discretion of the attending surgeon. Red flags that might lead a doctor to suspect tethered cord include any of its symptoms (although the same symptoms can be caused by a number of other spinal cord conditions); a previous diagnosis of a congenital spinal malformation; a history of cancer, infection, spine surgery; or spinal cord injury. (C) Postoperative lateral radiograph 3 years after surgery shows complete bone union and significant spine shortening. Frequent micturition, diminished knee and ankle reflexes, and difficulty in bending were exhibited in partial patients. Fatty Filum Terminale. Tethered Cord. 1A and B). 16. The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. A retrospective analysis of 82 adult patients (17 male cases, 82% and 24 female cases, 59%) with TCS treated by surgery was conducted between March, 2005 and December, 2015, with an average age of 31.6 years and average disease course of 6.7 years. 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. Tethering can happen before or after birth in children and adults; and most often occurs in the lower (lumbar) level of the spine. This study has two limitations in particular. Surgery may also restore some function or In conclusion, SSO appears to provide clinical improvement at least comparable to that achievable with the untethering procedure, especially in more challenging cases where successful untethering is quite difficult to achieve, such as cases of patients with complex malformations, arachnoid adhesions, and revision surgery. To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). 8600 Rockville Pike In this group of patients, postoperative pain symptoms of lumbosacral portion and both lower extremities improved significantly and remarkably, the defecation dysfunction in most patients was improved to some extent, but there were still some patients having frequent micturition and urinary retention; furthermore, muscle strength of lower limbs also increased, most patients had different degrees of improvement of muscle strength, which was basic consistent with the conclusion draw from Htittmann. Tubbs RS, Naftel RP, Rice WC, Liechty P, Conklin M, Oakes WJ. This causes extra stress on the nerves and can cause a range of symptoms known as tethered cord syndrome. The mean blood loss was 575.51316.5 mL in untethering surgery cases, but significantly greater in the SSO group: 1,971.81,739.2 mL (p<0.001). WebRecurrent tethered cord syndrome (TCS) can lead to significant progressive disability in adults. To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). . FOIA National Library of Medicine 2019 Feb;33(1):155-163. doi: 10.1007/s10877-018-0127-2. He underwent SSO 1.5 years after untethering surgery. The treatment of tethered cord syndromes in adults is discussed regarding the natural history and surgical indications. Most people have physical or occupational therapy to help regain function after surgery. Published by Wolters Kluwer Health, Inc. Although it was difficult to compare clinical outcomes due to the small numbers of patients and heterogeneity, SSO might be preferable for improving the symptoms in adult TCS after considering these baseline differences. A tethered spinal cord occurs when the inelastic tissue on the caudal spinal cord is abnormally attached to a structure instead of free floating. Clipboard, Search History, and several other advanced features are temporarily unavailable. Improvement in back pain and leg pain or numbness usually happens first, and bladder and bowel improvement happen last. Yamada S, Zinke DE, Sanders D. Pathophysiology of tethered cord syndrome. Mohd-Zin SW, Marwan AI, Abou Chaar MK, Ahmad-Annuar A, Abdul-Aziz NM. Recovery The neurological surgeon makes an incision in the lower back to expose the site where the spinal cord is pinned, then frees it by . [Intramedullary mature teratoma associated with an attached cord and an intradural lipoma. Some surgeons require the patient to remain flat in bed for a couple of days to minimize the risk of spinal fluid (CSF) leakage from the wound. Tight terminal filum is easy to manage and has excellent outcome, but the complexity of the other pathologies makes it difficult to achieve sufficient clinical results in those cases.7 As an alternative to untethering, Kokubun et al introduced spine-shortening osteotomy (SSO) for patients with TCS caused by a lipomyelomeningocele.11 SSO reduces the tension in the spinal cord and minimizes the perioperative complications.10 FOIA Pathology and treatment of tethered cord syndrome with lipoma. Log in now and start reading! Methods: 6 Of the 2515 patients, 85 adults with a tethered cord syndrome formed the basis of this study. Lew SM, Kothbauer KF. [7] Significantly different from children with TCS, there was also the existence of incentives in adult patients with TCS, such as hip hyperflexion due to high falling injury, lithotomy position delivery, long-time sitting causing over stretching of the spinal cord, all of which might evoke the development of TCS.[8]. Postraumatic syringomyelia involves development of a fluid-filled cavity (called a cyst or syrinx) within the spinal cord following a spinal cord injury. The mean estimated blood loss during surgery (300 ml in the open group vs 167 ml in the mini-open group, p = 0.313) and the mean length of stay (7 days in the open group vs 6.3 days in the mini-open group, p = 0.718) were similar between the 2 groups. There are different types of tethered cord. Symptoms may include back pain that radiates to the legs, hips, and the genital Two months later (a couple of weeks after her 10th birthday) on christmas break, she had surgery for the tethered cord (done by a neurosurgeon). Bone chips from the excised laminae and spinous processes were also placed over the T12 and L1 laminae for posterior fusion. Treatment helps patients with tethered spinal cord syndrome have a normal life expectancy. Revision surgery in patients with complex dysraphic lesions should be performed in exceptional cases only. 9 Patients with such complex pathologies have been found to have a 9 to 50% chance of worsening pain and sensorimotor deficits after untethering.7 Unlike pediatric patients, adults experience degenerative changes that further complicate treatment.5 During this call, the nurse will help decide which type of anesthesia is best for your child and if your child may have any risks with anesthesia. Funding/support: This study was supported by Peking Union Medical College Youth Research Funds (2016) (project no. Yamada S, Won D J, Pezeshkpour G. et al. The mean age of the patients was 46 13 years (range 23-74 . In adults, surgery to free the spinal cord can reduce the size and further development of cysts in the cord and may restore some function or alleviate other symptoms. collected, please refer to our Privacy Policy. Stretching and tension, especially in a growing child, can cause neurologic damage. Some patients may be misdiagnosed as having sciatica, a more common source of lower back . Nineteen (86%) of 22 employed patients returned to work after surgery. Recovery involves a period of immobility where the . Altered sensation (numbness or paresthesia) and bladder and/or fecal dysfunction were the most common complaints among 11 patients (79%). The effect of tethered cord release on coronal spinal balance in tight filum terminale. Of 40 cases without occupying lesions of TCS, the symptoms were improved in 14 cases and stabilized in 26 cases, there was no deteriorated case. . At surgery, the spinal cord was freed from its attachments to the dura, and the symptoms resolved [13]. and transmitted securely. For more information about these cookies and the data Successful detethering procedures require careful intradural Recovery from the surgery is one to two weeks of . Short-term postoperative results indicated a significant improvement of pain and a stabilization of neurological symptoms. Clinical features at presentation are summarized in Table 1. [2], Dermoid cyst should be completely removed together with cyst wall as much as possible, cystic wall residue is easy to cause the recurrence of cyst, although decreased volume of cyst can relieve the symptom of tethered, characteristics of dermoid cyst may lead greater possibility to TCS than lipoma. Selcuki M, Mete M, Barutcuoglu M, et al. Please try again soon. Search for Similar Articles Epub 2018 Mar 8. Yamada S, Lonser RR. (A) A 37-year-old male patient with a lumbar spinal lipoma at L3/L4 level. Primary is typically a form of OSD while secondary usually occurs following a myelomeningocele repair or other type of spinal cord surgery History and Exam Tethered spinal cord is most commonly diagnosed in infancy by the discovery of a abnormality noticed on the skin of the back. Your child will also need a COVID-19 PCR test 48 hours (2 days) before surgery. Of these patients, there were 34 males and 48 females, with an age range of 18 to 47 years (average age, 31.6 years), and average disease course of 6.7 years. Learn about the many ways you can get involved and support Mass General. Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients. In adults, symptoms of tethered cord usually develop slowly. There were 4 cases of patients with grade 0 by preoperative Hoffman grading, 20 cases with grade 1, 28 cases with grade 3, 18 cases with grade 4, 10 cases with grade 5, and remaining 2 cases with grade 6. At Mass General, the brightest minds in medicine collaborate on behalf of our patients to bridge innovation science with state-of-the-art clinical medicine. The surgical procedure performed at L1 is described below. modify the keyword list to augment your search. Tethered Cord Syndrome (TCS) is a complex of neurologic symptoms that include pain, incontinence, musculoskeletal deformities, motor weakness, and sensory abnormalities resulting from abnormal stretch placed on the distal spinal cord by congenital or acquired factors.