Tethered cord syndrome: overview of diagnosis and treatment

Yamada, Shokei; Won, Daniel J.; Siddiqi, Javed; Yamada, Shoko M.

doi:10.1179/016164104225017947

Cited by 45 publications

(23 citation statements)

References 12 publications

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“…The general result of the reported studies is that the incidence of tethered cord is greater in girls [5,7,8,14] . The study revealed that girls with diurnal enuresis aged 6-8 years had a slightly higher risk of tethered cord syndrome.…”

Section: Discussionsupporting

confidence: 49%

“…When the conus medullaris extends below the L 2 vertebral level, the fi lum is thicker than 2 mm in diameter even with a normallevel conus medullaris or a radiologically normal fi lum terminale with clinical appearance, the cord is considered tethered [11][12][13] . Partial traction on the spinal cord can lead to decreased local blood fl ow and impaired oxidative metabolism, resulting in neuronal dysfunction which manifests itself in neurologic, musculoskeletal and urologic abnormalities [2,14] . As the operative goal of untethering is to halt the progression of the neurological deficits, to stabilize and/or to reverse symptoms, early detection is strongly recommended [1,[15][16][17] .…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Primary Tethered Cord Syndrome Associated with Occult Spinal Dysraphism in Primary School Children in Turkey

Bademci

Saygun²,

Batay³

et al. 2005

Pediatr Neurosurg

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The prevalence and associated factors of primary tethered cord syndrome (PTCS) in primary school children were investigated. A cross-sectional study was performed in four demographically different primary schools in Turkey. Demographic, familial and physical data were collected from 5,499 children based on enuresis as a predominant symptom and dermatologic and orthopedic signs as clues of occult spinal dysraphism. Statistical analysis and input of the data were carried out with the SPSS package program 10.00, and logistic regression analysis was used to identify discriminating factors between enuretic children with or without neurologic signs. Of 5,499 analyzed children, 422 (7.7%) had enuresis nocturna, and 19.9% of 422 children had also daytime incontinence. Sixteen of these 422 enuretic children (3.8%) had several dermatologic signs. Five of them had spina bifida on plain radiographies, and 4 of them had cord tethering on lumbar MRI. Fifteen of 422 enuretic children (3.7%) had gait disturbances and orthopedic anomalies without cutaneous manifestations. Six of 15 children had spina bifida on plain graphies and 2 of them had tethered cord syndrome on MRI. The general prevalence of PTCS was found to be 0.1% of 5,499 analyzed children and 1.4% of enuretic children. A good outcome after untethering was found in 83.0% in this series. Practitioners should be aware of these clues of occult spinal dysraphism and resort to further radiologic and neurosurgical assessment. Early surgical intervention may halt the progression of the neurologic deficits and stabilize or reverse symptoms.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Prevalence of Primary Tethered Cord Syndrome Associated with Occult Spinal Dysraphism in Primary School Children in Turkey

Bademci

Saygun²,

Batay³

et al. 2005

Pediatr Neurosurg

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“…Both radiographic and surgical data may demonstrate a thickened filum, an intradural lipoma, and fibrous adhesions as the most common tethering lesions. 31,47 Less common tethering lesions in the adult include split cord malformation and a dermal sinus.…”

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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“…[15][16][17][18][19][20] Symptomatic tethering of the spinal cord following primary myelomeningocele repair occurs in 2.8% to 27% of patients. 9,16,18,19,21 The association of tethered cord with scoliosis has long been assumed.…”

mentioning

confidence: 99%

Response of Scoliosis in Children with Myelomeningocele to Surgical Release of Tethered Spinal Cord

Altıok

Riordan

Graf

et al. 2016

Topics in Spinal Cord Injury Rehabilitation

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Objective:To examine the effect of surgical tethered cord release (TCR) on scoliosis in children with myelomeningocele. Methods: A retrospective review of 65 pediatric patients with myelomeningocele and TCR. The final sample consisted of 20 patients with scoliosis who were managed conservatively after TCR. Results: Average age at TCR was 6.2 years with average follow-up of 3.8 years. Scoliosis of 1 (5%) patient improved, 7 (35%) were stable, and 12 (60%) worsened (≥10°). Fifty percent of patients ultimately required definitive spinal surgery. TCR release delayed definitive spine surgery for an average of 3.2 years. Sixty-four percent of patients with curves less than or equal to 45° had progression of their curves compared to 50% with curves greater than 45°. For patients with curves less than or equal to 45°, curves progressed in 80% of those younger than 10 years as compared to 25% of those older than 10 years. For patients with curves less than or equal to 45°, 43% required definitive spine surgery as opposed to 83% with curves greater than 45°. Level of neurological involvement (ie, lumbar versus thoracic) and age at untethering emerged as factors influencing the effects of TCR for patients with curves less than or equal to 45°. Lumbar curves had more favorable results. Conclusion: Pediatric patients with myelomeningocele and scoliosis should be closely assessed and monitored. A selective approach for youth with lumbosacral level myelomeningocele and progressive curves less than or equal to 45° may result in scoliosis stabilization and avoidance of definitive surgery.

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Tethered cord syndrome: overview of diagnosis and treatment

Cited by 45 publications

References 12 publications

Prevalence of Primary Tethered Cord Syndrome Associated with Occult Spinal Dysraphism in Primary School Children in Turkey

Prevalence of Primary Tethered Cord Syndrome Associated with Occult Spinal Dysraphism in Primary School Children in Turkey

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

Response of Scoliosis in Children with Myelomeningocele to Surgical Release of Tethered Spinal Cord

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