Tethered cord syndrome-role of early surgery

Vepakomma, Deepti; Kumar, Nitin; Alladi, Anand

doi:10.4103/jiaps.jiaps_49_18

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…19,20 If this condition is treated promptly after the appearance of deficits, it shows better postoperative outcome. 17,18 Klekamp studied 85 adult TCS patients and concluded that surgery in adult patients with a TCS reserved for those with symptoms and a conservative approach was warranted in adult patients without neurological deficits. 21 In our series, we detethered filum at the lowest possible level as close to the thecal attachment as possible and this will avoid any injury to roots and neural tissue and preferential beyond L5 to S1 level.…”

Section: Discussionmentioning

confidence: 99%

“…15 It is commonly believed that children, who have a congenital tethered cord, get benefit from surgical detethering because it prevents neurological deterioration. [16][17][18] The same rationale is extended to adult TCS also. It is believed that patients with primary tethered cord will sooner or later experience worsening of neurological deficits if they do not undergo spinal cord detethering.…”

Section: Discussionmentioning

confidence: 99%

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A Study of Outcome of Detethering in Delayed Presentation of Tethered Cord Syndrome

Beniwal,

K.,

et al. 2024

Indian Journal of Neurosurgery

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Introduction Tethered cord syndrome (TCS) is a stretch-induced functional disorder associated with tethering of caudal spinal cord to dura mater with inelastic tissue, limiting its movement. It not only manifests in childhood but also noted in adults. Here, we studied the role of detethering on delayed presentation of TCS. Material and Methods All patients of symptomatic TCS from January 2011 to December 2019 were included. Preoperative evaluation was done through X-ray; ultrasonography kidney, ureter, urinary bladder; magnetic resonance imaging spine and brain; and urodynamic studies. Detethering was done and associated pathology was excised. Preoperative and postoperative comparison was done through Necker functional score using chi-squared system. Results Age range was 8 to 30 years with mean age of 13.8 years. Most common presentation was urological manifestations in ∼61.1% of cases followed by pain in 41.6%, sensory deficits in 38.8%, asymmetric weakness in 30.5%, orthopaedic and trophic ulcers in 22.2% each, and bowel abnormalities in 13.8% of cases. Mean duration of symptoms was 5.52 years. Improvement in urological manifestations was in 71.4% patients, pain in 80%, sensory dysfunctions in 71.4%, bowel dysfunctions in 80%, motor weakness in 90.9%, and trophic ulcer in 100% patients. On comparison, chi-squared value was 25.9993 and p-value was 0.000032, which was significant (<0.05). Conclusion Detethering in early ages is already proven with good results. In our study, detethering showed statistically significant improvement even in delayed presentation. So, authors recommend to surgically interfere by detethering, even if tethering is detected late with significant deficits.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Study of Outcome of Detethering in Delayed Presentation of Tethered Cord Syndrome

Beniwal,

K.,

et al. 2024

Indian Journal of Neurosurgery

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“…Of 64 children treated with prophylactic surgery for thickened or fatty filum, none had a new onset of symptoms after a mean of 6.6 years of follow-up [ 18 ]. Outcomes are superior for children when operated on at less than one year of age; older children with deficits are less likely to recover [ 19 ]. As many as 30% of patients may require a second, third, or fourth untethering after the initial surgery [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Tethered Cord Syndrome: Role of Imaging Findings in Surgical Decision-Making

Otto,

Kucera,

Hayes

et al. 2023

Cureus

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For infants presenting with urinary problems or lower extremity weakness, imaging is ordered to investigate spinal pathology. Tethered cord syndrome (TCS) often manifests without conclusive anatomic evidence. In our case, a premature infant presented with urosepsis and was found to have an asymmetric gluteal crease and a sacral dimple. Renal ultrasound showed mild hydronephrosis, and a cystourethrogram revealed bilateral high-grade vesicoureteral reflux. Ultrasound and magnetic resonance imaging demonstrated a borderline low-lying spinal cord at the mid-L3 vertebral level. Urodynamic testing to confirm neurogenic bladder could not be completed on the first attempt due to urinary tract infection and on the second attempt due to instrument intolerance. Despite the lack of conclusive imaging evidence of a tethered cord, enough supportive clinical data was present to proceed with surgical intervention with the goal of preventing the progression of neurological dysfunction. Because TCS is ultimately a clinical diagnosis, appropriate management should not be discouraged by inconclusive or borderline imaging findings.

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Tethered cord release in patients after open fetal myelomeningocele closure: intraoperative neuromonitoring data and patient outcomes

et al. 2022

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Purpose: To better understand the clinical course and impact of tethered cord release surgery on patients who have previously undergone open spinal dysraphism closure in utero.Methods: This is a single-center retrospective observational study on patients undergoing tethered cord release after having previously had open fetal myelomeningocele (MMC) closure. All patients underwent tethered cord release surgery with a single neurosurgeon. A detailed analysis of the patients' preoperative presentation, intraoperative neuromonitoring (IONM) data, and postoperative course was performed.Results: From 2009 to 2021, 51 patients who had previously undergone fetal MMC closure had tethered cord release surgery performed. On both preoperative and postoperative manual motor testing, patients were found to have on average 2 levels better than would be expected from the determined anatomic level from fetal imaging. The electrophysiologic functional level was found on average to be 2.5 levels better than the anatomical fetal level. Postoperative motor levels when tested on average at 4 months were largely unchanged when compared to preoperative levels. Unlike the motor signals, 46 (90%) of patients had unreliable or undetectable lower extremity somatosensory evoked potentials (SSEPs) prior to the tethered cord release.Conclusion: Tethered cord surgery can be safely performed in patients after open fetal MMC closure without clinical decline in manual motor testing. Patients often have functional nerve roots below the anatomic level. Sensory function appears to be more severely affected in patients leading to a consistent motor-sensory imbalance.

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Tethered cord syndrome-role of early surgery

Cited by 6 publications

References 13 publications

A Study of Outcome of Detethering in Delayed Presentation of Tethered Cord Syndrome

A Study of Outcome of Detethering in Delayed Presentation of Tethered Cord Syndrome

Tethered Cord Syndrome: Role of Imaging Findings in Surgical Decision-Making

Tethered cord release in patients after open fetal myelomeningocele closure: intraoperative neuromonitoring data and patient outcomes

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