Reduction of caudal traction force using dural sac opening rather than spinal cord detethering for tethered cord syndrome caused by lipomyelomeningocele: a case report

Murata, Yoshinori; Kanaya, Kazuko; Wada, Hiroyoshi; Wada, Keiji; Shiba, Masahiro; Kato, Yoshiharu

doi:10.1016/j.spinee.2014.02.031

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…Murata et al described improvement in a patient with a large lumbosacral lipoma through decompression of the thecal contents without direct untethering, supporting a compressive pathophysiology in at least some patients. 15 A combination of these factors probably contributes (with different ana- tomical configurations of the lipoma, the cord-lipoma interface, and the tissues in the lipoma) to predispose some patients to deterioration. In our study, patients in the ED group had more expansive lipomas that filled the intact spinal canal while displacing/compressing the conus and cauda equina.…”

Section: Discussionmentioning

confidence: 99%

Radiographic predictors of deterioration in patients with lumbosacral lipomas

Hengel

Cochrane

2016

PED

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OBJECTIVE Although patients with lumbosacral lipomas may be asymptomatic at presentation, most develop neurological symptoms over time. Given the challenges in examining infants, the authors sought to determine whether MRI would be helpful in identifying patients who are more likely to deteriorate early in life and who would potentially benefit from early surgical intervention. METHODS A retrospective review of all patients with lumbosacral lipomas who were seen at the authors' institution between 1997 and 2013 and who were managed without prophylactic surgery was performed. The clinical history and imaging results for each patient were reviewed in detail and then correlated to the pattern of and age at clinical deterioration. RESULTS Twenty-four patients were identified. Nine worsened within the first 18 months of life (early deterioration), and 15 patients deteriorated or remained stable after 30 months (late deterioration/stable). No patients worsened between 18 and 30 months of age. Patients who deteriorated early were more likely to have large intradural lipomas that filled the canal, increased during the 1st year of life, and compressed neurological structures. Some had a syrinx extending above the neural-lipoma interface. Syrinxes in patients with early deterioration were large and expanded in infancy. Patients with early deterioration had motor deficits at the time of deterioration, whereas patients with late deterioration developed mixed urological and motor dysfunction. CONCLUSIONS Patients with large lipomas displacing the cord and an enlarging syrinx have a propensity for early clinical deterioration. Given this, their families may be counseled that 1) the risk of deterioration in infancy may be higher than in infants without these features, and 2) they require more diligent observation. Intervention before deterioration in these infants should also be considered. Patients without these features may be safely observed to a lesser extent.

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Section: Discussionmentioning

confidence: 99%

Radiographic predictors of deterioration in patients with lumbosacral lipomas

Hengel

Cochrane

2016

PED

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“…Symptoms in patients with combined and lipomyelomeningocele TCS was relatively heavier, fat surrounded multiple bundle of cauda equina, dissociating of the cauda equina was therefore more difficult, and it was difficult to be completely removed, also accompanied with subsidiary-injury recurrence of TCS, finally resulting in poor prognosis and none significant improvement of symptoms. [17] …”

Section: Discussionmentioning

confidence: 99%

Surgical treatments on adult tethered cord syndrome

Gao

Kong

et al. 2016

Medicine

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To investigate effects of surgical treatment on adult tethered cord syndrome (TCS).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. All the 82 cases of patients received nerve electrophysiology monitoring assisted microsurgery. After surgery, all patients were followed up for an average of 2.5 years. Surgical effects were evaluated according to Hoffman grading system. As this is just a retrospective study that does not involve any interventions, ethical approval was not necessary according to the rules of the hospital.All patients were followed up, no death occurred. According to Hoffman grading system, the neurologic symptoms were improved in 22 patients (27%), stabilized in 60 patients (73%). Of 10 cases with lipoma tethered spinal cord, corresponding symptoms were improved in 2 cases. Of 32 cases with tethered spinal cord caused by dermoid cyst and epidermoid cyst, the symptoms were improved in 6 cases. Of 40 cases without occupying lesions of tethered spinal cord, the symptoms were improved in 14 cases. Besides, there was no deteriorated case.Surgical treatment on adult patients with TCS can improve the neurologic deficits which are associated with the course of disease, early treatment has much better curative effect.

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Reduction of caudal traction force using dural sac opening rather than spinal cord detethering for tethered cord syndrome caused by lipomyelomeningocele: a case report

Cited by 2 publications

References 16 publications

Radiographic predictors of deterioration in patients with lumbosacral lipomas

Radiographic predictors of deterioration in patients with lumbosacral lipomas

Surgical treatments on adult tethered cord syndrome

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