Scoliosis may be the first symptom of the tethered spinal cord

Abstract

Background:Tethered cord syndrome (TCS) is a progressive clinical entity that arises from abnormal spinal cord tension. Scoliosis may be a unique symptom in TCS. The aim of this study is to investigate prognosis after releasing the filum terminale in scoliosis due to TCS with/without findings in magnetic resonance imaging (MRI) and to draw attention to the importance of somatosensorial evoked potentials (SSEP) on the differential diagnosis of idiopathic scoliosis versus scoliosis due to TCS with normal appearance of filum terminale and conus medullaris.Materials and Methods:Eleven female and seven male patients with progressive scoliosis were included in the study. They were evaluated radiologically, SSEP and urodynamical studies. Preoperative and postoperative anteroposterior full spine X-rays were obtained for measuring the Cobb's angle. MRI was performed in all cases for probable additional spinal abnormalities. All patients underwent filum terminale sectioning through a L5 hemilaminectomy. The resected filum terminale were subjected to histopathological examination.Results:The mean Cobb angle was 31.6° (range 18°–45°). Eight patients (44.45%) had a normal appearance of filum terminale and normal level conus medullaris in MRI, but conduction delay and/or block was seen on SSEP. In the histopathological examination of filum terminale dense collagen fibers, hyaline degeneration and loss of elastic fibers were observed. Postoperatively none of the patients showed worsening of the Cobb angle. Three patients showed improvement of scoliosis.Conclusion:In TCS presented with scoliosis, untethering must be performed prior to the corrective spinal surgery. Absence of MRI findings does not definitely exclude TCS. SSEP is an important additional guidance in the diagnosis of TCS. After untethering, a followup period of 6 months is essential to show it untethering helps in stopping the progress of the scoliotic curve. In spite of non progression (curve stopped lesser than 45°) or even improvement of scoliosis, there may be no need for major orthopedic surgical intervention.

Etiological Theories of Adolescent Idiopathic Scoliosis: Past and Present

“…left thoracic curve), have pain, or are being screened prior to surgery [ 125 ]. Furthermore, according to Barutçuoğlu et al [ 126 ], the absence of MRI findings does not definitively exclude TCS. The authors point out that somatosensorial evoked potentials or SSEP is an important additional guidance in making a diagnosis of tethered cord syndrome [ 126 ].…”

‘The Association of Scoliosis Properties with Spinal Cord Tethering: A Statistical Model for Prognostication’

“…(6)(7)(8)(9)(10) Tethered cord syndrome is highly correlated with scoliosis. (11)(12)(13)(14)(15) For those patients with symptomatic or subclinical cord-tethering problems, a cord-releasing procedure before realigning surgery is proposed. (16) During realignment, tension can be imposed on the spinal cord, potentially causing a neurological deterioration.…”

Is detethering necessary before deformity correction in congenital scoliosis associated with tethered cord syndrome: a meta-analysis of current evidence

“…Tethered cord syndrome (TCS) is the commonest reported anomaly present in about 12 to 17% of the patients suffering from CS [1,3]. While in its simplest form TCS is associated with a thickened (< 2 mm) and contracted (cord ending below L2-L3 disc space) filum, it may also be caused due to other pathologies of neural tube formation [6]. TCS leads to extensive tension on the spinal cord and, apart from neurological deficit, has also been implicated as a cause of scoliosis by a number of researchers [7,8].…”

“…The rationale behind prophylactic detethering is to avoid the risk of damaging an already compromised cord due to the lengthening of the spinal column associated with the deformity correction procedure. Moreover, A few researchers have also recommended staged procedures in order to allow spontaneous correction or cessation of progression of deformity following detethering [6,[13][14][15]. However, the staged approach is associated with a number of disadvantages such as morbidity due to a second admission and anaesthesia, delayed recovery time and risk of neurological injury due to the detethering procedure itself [9,[16][17][18].…”