Tethered-cord syndrome after repair of meningomyelocele

Balasubramaniam, Chidambaram; Laurent, John P.; McCluggage, Charles W.; Oshman, D.; Cheek, William R.

doi:10.1007/bf01850974

Cited by 26 publications

(19 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[1][2][3]7,9,18 Typically, this retethering occurs after the repair of myelomeningoceles and lipomyelomeningoceles. However, retethering after the transection of a fatty filum terminale has been rarely recognized.…”

mentioning

confidence: 99%

Retethering of transected fatty filum terminales

Ogiwara¹,

Lyszczarz²,

Alden³

et al. 2011

PED

View full text Add to dashboard Cite

Object Untethering of a tethered spinal cord (TSC) by transecting or removing a fatty filum terminale is a relatively simple procedure that can prevent or ameliorate neurological symptoms, and the postoperative prognosis is usually good. Progressive neurological deterioration caused by recurrent tethering has been rarely reported. The authors present their experience in cases in which a sectioned fatty filum terminale has become retethered. Methods The authors retrospectively analyzed the surgical results of pediatric patients with fatty filum terminale–TSC treated by transection of the filum. The patients' charts were reviewed for demographic data, clinical presentation, surgical therapy, and follow-up data. Results Of the 225 children who underwent TSC release by sectioning the fatty filum from 1992 to 2005, there were 6 patients (2.7%; 3 males, 3 females) in whom the fatty filum retethered. The mean age at the first diagnosis of TSC was 5.2 years (range 2 months–12.3 years). The mean duration from the first untethering procedure to retethering was 5.4 years. The mean age at the time of retethering was 10.6 years (range 7–17.5 years). Symptoms of retethering were urinary incontinence, low-back pain, difficulty walking, constipation, leg pain, and worsening foot deformity. Patients underwent cystometrography at the time retethering was indicated by increased bladder capacity, large post-void residual volume, decreased bladder capacity, increase in filling pressure, and poor sensation of filling. Magnetic resonance imaging revealed adherence of the rostral stump of the sectioned filum to the midline dorsal dural surface. All patients underwent the second untethering procedure. Four patients improved neurologically and experienced no retethering thereafter (mean follow-up period 5.5 years). Two patients experienced additional retethering after temporary improvement following the second untethering procedure. Conclusions Retethering of the spinal cord is a rare condition occurring after the sectioning of a fatty filum terminale. Awareness of this rare sequela is necessary for appropriate long-term management of TSC caused by a fatty filum terminale. Cystometrography is useful for detecting the lesion and confirming the diagnosis of retethering.

show abstract

mentioning

confidence: 99%

Retethering of transected fatty filum terminales

Ogiwara¹,

Lyszczarz²,

Alden³

et al. 2011

PED

View full text Add to dashboard Cite

show abstract

“…The specificity of anatomical cord tethering [14,15] in making the diagnosis of symptomatic cord tethering is low. This may be improved if, in addition to the tethering, arachnoiditis is present on MR or CT myelography.…”

Section: Discussionmentioning

confidence: 99%

Functional Deterioration following Placode Untethering in Myelomeningocele

1998

View full text Add to dashboard Cite

Placode untethering in myelomeningocele patients can result in improvement and/or stabilization of neurological function, spinal curvature and pain. This paper reviews the outcome of untethering procedures in 24 patients to determine the frequency of subsequent functional deterioration. Decreased range of movement, joint stiffness and changes in muscle tone were the commonest indications for surgical intervention, occurring in 15 patients. Untethering resulted in improvement in 8 patients, stabilization of progression in 6 and continued deterioration in 1 patient. Two patients previously untroubled with spasticity became symptomatic within 3 months of the procedure. Changes in ambulation were present preoperatively in 9 patients. Stabilization was observed in 4 and improvement in 5. One of the patients, who had improved, deteriorated during the 1st year of follow-up. Alterations in bladder capacity and continence occurred in 7 patients. Improvement was seen in 2 patients, deterioration in 2 and no change in 3. Of the patients who improved, 1 subsequently deteriorated again within the 2nd postoperative year. Of those patients who had stable bladder function preoperatively, 6 subsequently deteriorated despite untethering. Pain was a less frequent symptom, occurring in 6 patients. Six patients became pain-free within 3 months of untethering. Two patients who did not have pain preoperatively had pain at the operative site persisting for up to 3 months postoperatively. Of the 20 patients having a single untethering procedure to date, 11 have further symptoms that can be attributed to retethering.

show abstract

“…Myelomeningocele (MMC) is the most common (1per /1000 births) form of neural tube defects which requires a closure operation immediately after birth for preventing infection and trauma to open spinal cord (7). In postoperative years, many patients develop tethering of spinal cord due to previous MMC operation which is known as secondary tethered spinal cord (8). Untethering operations of secondary tethered spinal cords due to MMC are more challenging because of the scar tissue, attachments and abnormal neuroanatomy.…”

Section: Introductionmentioning

confidence: 99%

The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele

Canaz¹,

Erdoğan²,

Alataş³

2018

Kocaeli Med J

View full text Add to dashboard Cite

ÖZ GİRİŞ ve AMAÇ: İntraoperatif nöromonitörizasyon, hem primer hem de sekonder gergin omurilik operasyonlarında, operasyonun daha güvenli gerçekleşmesi ve kompleks operasyonlarda cerraha yol göstermesi adına bir gereklilik olarak kabul edilir. Bu makalede, çocuklarda iki farklı operasyonun nöromonitörizasyon sonuçları ve postoperatif klinik değişimleri yer almaktadır: okült spinal disrafizm ve geçmiş myelomeningosel onarımına sekonder gergin omurilik. YÖNTEM ve GEREÇLER: Yirmi dört operasyon üç modalite ile monitörize edildi: transkraniyal motor uyarılmış potansiyeller (TcMEP), sürekli elektromiyografi (EMG) ve direkt sinir stimülasyonu (DNS). Grup 1'de okült spinal disrafizme bağlı gergin omurilik operasyonu geçirmiş 14 hasta, grup 2'de geçmiş myelomeningosel onarımına sekonder gergin omurilik operasyonu geçirmiş 10 hasta bulunuyordu. BULGULAR: Alt ekstremitelerden TcMEP yanıt elde etme oranı grup 1'de %92, grup 2'de %80 olarak bulundu. Anal sfinkterden TcMEP yanıt elde etme oranı grup 1'de %83, grup 2'de %60 olarak bulundu. Her iki grupta da operasyonlar esnasında TcMEP değişikliği görülmedi. Her iki grubun postoperatif ürodinami sonuçları 1 yıl periyodu içerisinde iyileşti (grup 1'de %78, grup 2'de %43). Hipoaktif mesaneli hastalarda TcMEP'te anal sfinkter yanıtları alınamadı. Yeni ya da kötüleşmiş postoperatif nörolojik defisit görülmedi. TARTIŞMA ve SONUÇ: Hem asemptomatik okült spinal disrafizm hem de MMC'ye sekonder TCS'de spinal kordun serbestleştirilmesi bozulmuş ürodinami sonuçlarını iyileştirebilir. İntraoperatif nöromonitörizasyon ve direkt stimülasyon daha güvenli bir ameliyat için bilgi sağlayabilir ve özellikle sekonder serbestleştirmede cerrahi manevraları yönlendirebilir. İntraoperatif nörofizyolojik monitörizasyon, kalan motor fonksiyonları korumak adına nörolojik defisitli MMC hastalarının operasyonlarında yararlıdır. Anal sfinkter fonksiyonları ile mesane fonksiyonları arasında korelasyon olduğundan hasta hipoaktif mesaneye sahipse anal sfinkterden TcMEP yanıtı alınamayabilir. Anahtar Kelimeler: İntraoperatif nöromonitörizasyon, gergin omurilik sendromu, myelomeningosel, motor uyarılmış potansiyeller ABSTRACT INTRODUCTION: Using intraoperative neuromonitoring in both primary and secondary tethered cord operations is accepted as a necessity for a safer operation and guiding surgeon in complex surgeries. METHODS: Twenty four operations which were monitored with three modalities; transcranial motor evoked potentials (TcMEP), free-run electromyography and direct nerve stimulations. In group 1, there were 14 patients underwent tethered cord operations due to occult spinal dysraphism, in group 2 there were 10 patients underwent tethered cord operations secondary to previous myelomeningocele repair. RESULTS: TcMEP responses of lower extremity were elicited in 92 % in group 1, 80 % in group 2. TcMEP responses of anal sphincter were elicited in 83 % in group 1, 60 % in group 2. No TcMEP change was observed during the surgeries in both group. Postoperative urodynamic results of both group were improved ...

show abstract

Tethered-cord syndrome after repair of meningomyelocele

Cited by 26 publications

References 16 publications

Retethering of transected fatty filum terminales

Retethering of transected fatty filum terminales

Functional Deterioration following Placode Untethering in Myelomeningocele

The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele

Contact Info

Product

Resources

About