Surgery in adults with tethered cord syndrome: outcome study with independent clinical review

Leeuwen, Robert van; Notermans, N. C.; Vandertop, W. P.

doi:10.3171/spi.2001.94.2.0205

Cited by 51 publications

(49 citation statements)

References 17 publications

(16 reference statements)

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“…More recently, McLone 28 described 3 categories: 1) those who were previously asymptomatic presenting with signs and symptoms of cutaneous stigmata; 2) the true occult group presenting with signs and symptoms and no cutaneous stigmata; and 3) those with a previous diagnosis of spinal dysraphism, with or without a detethering or repair procedure, with stable or progressive deficits.As stated previously, the adult presentation of TCS is similar to that in adolescent patients, with back or leg pain as a predominant feature. 18,25,31,36,42 The pain is most often nondermatomal, shocklike, or with a burning quality. Mostly the pain is insidious, but may present with acute onset or aggravation of existing pain.…”

Section: Adult Presentation Of Tcsmentioning

confidence: 99%

Tethered cord syndrome: a review of the literature from embryology to adult presentation

Hertzler¹,

DePowell²,

Stevenson³

et al. 2010

FOC

218

142

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Tethered cord syndrome (TCS) is a clinical condition of various origins that arises from tension on the spinal cord. Radiographic findings may include the conus medullaris in a lower than normal position, fatty infiltration of the filum terminale, lipomyelomeningocele, myelomeningocele, myelocystocele, meningocele, split cord malformations, dermal sinus, anorectal malformations, and intraspinal tumors. The clinical constellation of signs and symptoms associated with TCS may include dermatologic, urological, gastrointestinal, neurological, and orthopedic findings. The current review focuses on TCS by age group of the more common causes of the condition, including myelomeningocele, lipomyelomeningocele, as well as the adult presentation of occult TCS. Pertinent review of the neuroembryology and normal anatomical position of the conus medullaris is included.

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Section: Adult Presentation Of Tcsmentioning

confidence: 99%

Tethered cord syndrome: a review of the literature from embryology to adult presentation

Hertzler¹,

DePowell²,

Stevenson³

et al. 2010

FOC

218

142

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“…Despite the management of congenital TCS diagnosed in adulthood remains controversial, results of recent clinical studies of surgical intervention in adults are encouraged (7,9,12,14,19). The question here, how can neurosurgeons manage this complex entity to protect the patients from new deficits and keep their neurological functions intact?…”

mentioning

confidence: 99%

Management of tethered cord syndrome in adults: experience of 23 cases

Sofuoğlu

Abdallah²,

Emel³

et al. 2015

Turkish Neurosurgery

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ABSTRACTfrom folic acid deficiency. In contrast, TCS is rarely diagnosed in adults as well as it is a complex clinicopathological entity that remains poorly understood.The incidence of neural tube defects is 0.17-6.39 per 1000 live births worldwide (2). TCS is one of the common spinal dysraphic lesions which have been reduced in developed countries due to supplementation of folic acid during pregnancy and prenatal diagnosis of dysraphic malformations █ InTRODuCTIOn T ethered cord syndrome (TCS) is a deterioration involving an abnormal stretching of the tethered spinal cord, the ascent of which is limited and is disproportionate to the growth of the spinal column (9,13). TCS is not a rare pathological disorder particularly in developing countries. This congenital syndrome usually associates to other syndromes may develop in children who are born to mothers suffered AIM: Tethered cord syndrome (TCS) is rarely diagnosed in adults. It is a complex clinicopathological entity that remains poorly understood. In this study, clinical outcomes of 23 consecutive congenital TCSs diagnosed in adults have been evaluated to establish a standard approach to treat congenital TCS diagnosed in adults. MATERIAL and METhODS:Medical records were retrospectively reviewed in 73 cases of TCS who were underwent surgery in our hospital, between 2005 and 2014. Cases which diagnosed and treated surgically in adults (patient age > 18 years) were included in this study. RESuLTS:Twenty-three adult cases of TCSs were treated surgically and 15 of them were female and 8 were male. The mean age was 30.3±10.7 years. The mean follow-up period was 75.6±40.5 months. The most common complaint was low back pain. The most common findings in the neurological examinations were muscular weakness and urinary incontinence. The most common co-malformations were diastematomyelia and vertebral fusion anomalies. Conus medullaris was mostly terminated at the L5 level. Detethering procedure was carried out in 87% of patients and bony septum resection without detethering was applied in 13%. Laminoplasty was performed only in 39.1%. 60.9% of patients were recovered good. 34.8% of patients were improved. The most common complication was cerebrospinal fluid leakage.COnCLuSIOn: Despite the good results obtained in our surgical interventions for symptomatic TCS in adults, tethered cord releasing is complex procedure and has serious complications. Therefore, it is suggested to plan surgery according to symptoms emphasized with full neurological examination, craniospinal imaging and urodynamic tests.

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“…25 George and Fagan 25 found only 7 case reports and case series reporting clinical experiences with this condition up through 2003. 21,52,65,67,74,79,82 The magisterial 1982 paper by Pang and Wilberger 67 on tethered spinal cord in adults includes a single patient with a sacral myelomeningocele who was investigated using metrizamide CT myelography. In addition to tethering at the site of the repair, this patient had a tight filum terminale.…”

Section: Spinal Cord Tetheringmentioning

confidence: 99%

“…Twelve patients had undergone tethered cord release, but the ages at which this intervention was performed were not stated. Van Leeuwen et al 82 reported a large institutional series of adults operated for tethered cord syndrome that included 12 patients with myelomeningocele and secondary tethering. Three of 12 patients enjoyed postoperative improvements of 1 or 2 points on a modified Rankin Scale; no other data specific to myelomeningocele were reported.…”

Section: Spinal Cord Tetheringmentioning

confidence: 99%

Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults

Piatt¹

2010

PED

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Object Myelomeningocele is the most severe congenital malformation of the CNS that is compatible with survival. From the time of the development of practical treatment for hydrocephalus in the late 1950s, affected individuals began to survive into adulthood in substantial numbers. Data on the neurological status of these individuals are sparse, as are descriptions of their continuing requirements for neurosurgical care. Methods A review of the literature was undertaken using the PubMed database maintained by the National Library of Medicine. Formal grading of the quality of evidence was not attempted, but methodological issues affecting validity or generalizability were noted. Results Observations from 2 major longitudinal studies of cohorts of patients treated without selection using contemporary neurosurgical techniques have been published at intervals beginning in the mid-1970s. Numerous cross-sectional, institutional reviews have focused on neurosurgical issues in adulthood: hydrocephalus, Chiari malformation Type II and syringomyelia, and secondary spinal cord tethering. The organization of medical services for adults with myelomeningocele has received limited study. Conclusions Surviving adults with myelomeningocele achieve a wide range of neurological and functional outcomes, the most critical and adverse determinant of which is symptomatic CSF shunt failure. From a neurosurgical standpoint, adults with myelomeningocele remain clinically active indefinitely, and they deserve periodic neurosurgical surveillance.

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Surgery in adults with tethered cord syndrome: outcome study with independent clinical review

Cited by 51 publications

References 17 publications

Tethered cord syndrome: a review of the literature from embryology to adult presentation

Tethered cord syndrome: a review of the literature from embryology to adult presentation

Management of tethered cord syndrome in adults: experience of 23 cases

Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults

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