Occult dysraphism in adulthood: clinical course and management

Klekamp, Jörg; Raimondi, Anthony J.; Samii, Madjid

doi:10.1007/bf00335170

Cited by 37 publications

(24 citation statements)

References 40 publications

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“…The clinical presentation of these patients is similar to that reported in previous studies, 2,5,6,8,10,11,13,16,17 stressing the predominance of patients presenting with pain-this being the major difference between adult and pediatric presentations. The surgical complication rate is low.…”

Section: Discussionsupporting

confidence: 83%

“…The incidence of OSD is unknown and, although it is likely that some patients remain asymptomatic and a diagnosis is never made, a subset of patients with the congenital syndrome develop progressive symptoms and signs in adulthood. 2,5,10,12,13 Such deterioration may occur after sudden movements that cause traction on the spinal cord. 10 These may include bending movements, the lithotomy position during childbirth, movement occurring during motor vehicle accidents, and others.…”

Section: Discussionmentioning

confidence: 99%

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Congenital tethered spinal cord syndrome in adults

Iskandar¹,

Fulmer²,

Hadley³

et al. 2001

FOC

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Object The management of tethered 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. To ascertain the results of surgery in adult patients with this anomaly, the authors undertook a retrospective review of 34 cases. Methods The authors studied the hospital records of 34 consecutive patients who presented in adulthood with tethered cord syndrome and conducted follow-up phone interviews with 28 of them. The population consisted of 12 men and 22 women, ranging in age from 18 to 70 years (mean 34 years). The most common presenting feature was pain, followed by weakness and incontinence. All patients underwent surgery. The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies. Long-term surgical results and patient outcome ratings were encouraging. After a mean clinical follow-up period of 4 years, significant improvement occurred in 22 of 27 patients presenting with pain, 13 of 27 patients with motor or sensory dysfunction, and 11 of 18 patients with bowel and bladder disturbance. In addition, telephone interviews were obtained after a period of 8.6 years. Twenty-two (79%) of 28 patients called the operation a long-term success; 21 (75%) of 28 patients believed that they had significant postoperative improvement (and not just stabilization) in pain and/or neurological function. Surgical complications were generally minor. Surgery-related complications included one cerebrospinal fluid leak and five pseudomeningoceles. Two patients complained of worsening motor or sensory dysfunction and one of worsening bladder dysfunction, whereas four patients experienced persistent pain and one complained of worsening pain postoperatively. According to the patients, the vast majority of these complications were minor. Nineteen (86%) of 22 employed patients returned to work after surgery. Two (33%) of six patients who were not employed before surgery worked full time postoperatively. Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work. Conclusions Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. Because neurological deficits are generally irreversible, early surgery is recommended.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Congenital tethered spinal cord syndrome in adults

Iskandar¹,

Fulmer²,

Hadley³

et al. 2001

FOC

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“…This complication rate is similar to that reported by others (11-17%). 9,11 The reported mortality rate for TCR is also low. There was one patient in our study who died several days postoperatively of acute respiratory distress syndrome and sepsis.…”

Section: Surgical Managementmentioning

confidence: 91%

Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients

Rajpal

Tubbs

George

et al. 2007

SPI

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Object Children with spina bifida occulta require early surgery to prevent neurological deficits. The treatment of patients with a congenitally tethered cord who present in adulthood remains controversial. Methods The authors studied the medical records of 61 adult patients who underwent surgical untethering for spina bifida occulta at three institutions between 1994 and 2003. Patients who had undergone prior myelomeningocele repair or tethered cord release surgery were excluded. The most common intraoperative findings were lipomyelomeningocele (41%) and a tight terminal filum (36%). The follow-up duration ranged from 10.8 to 149.5 months. Of the 34 patients with back pain, status improved in 65%, worsened in 3%, remained unchanged in 18%, and improved and later recurred in 15%. Lower-extremity pain improved in 16 patients (53%), remained unchanged in 23%, improved and then recurred in 17%, and worsened in 7%. Lower-extremity weakness improved in 47%, remained unchanged in 47%, and improved and then recurred in 5%. Finally, of the 17 patients with lower-extremity sensory changes, status improved in 35%, remained unchanged in 35%, and the information on five patients was unavailable. Surgical complications included three wound infections, one cerebrospinal fluid leak, and two pseudomeningoceles requiring surgical revision. One patient developed acute respiratory distress syndrome and sepsis postoperatively and died several days later. Conclusions Adult-age presentation of a congenital tethered cord is unusual. Despite a slight increase in postoperative neurological injury in adults, surgery has relatively low risk and offers good potential for neurological improvement or stabilization. As they do in children, the authors recommend early surgery in adults with this disorder. The decision to undertake surgery, however, should be modulated by other factors such as a patient's general medical condition and risk posed by anesthesia.

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“…After an initial period of enthusiasm, in which surgery was recommended for all spinal lipomas and was considered to be a safe and effective procedure (8,28), many authors have stressed how a complex anatomy may influence the results of surgery, increasing the risk of postoperative damage (4,5,7,10,31). The results of surgery in occult spinal dysraphisms is still a matter of debate.…”

Section: Response To Surgerymentioning

confidence: 98%