Tethered spinal cord syndrome in adults in the MRI era: recognition, pathology, and long-term objective outcomes

Abstract

OBJECTIVE Tethered cord syndrome (TCS) has been well described in pediatric patients. Many recent reports of TCS in adult patients have grouped retethering patients with newly diagnosed ones without separately analyzing each entity and outcome. The authors reviewed their experience of newly diagnosed adult TCS patients to identify and explore TCS misdiagnosis, recognition, subtype pathology, and individual objective outcomes. METHODS This study included 24 adult patients (20 female and 4 male) who fit the criteria of being newly diagnosed and aged 20 years and older (age range 20–77 years). Preexisting dermal sinus was present in 6 patients, hypertrichosis in 5, skin tag/cleft/dimple and fatty subcutaneous masses in 5, scoliosis in 2, and neurological abnormalities in 4 patients. The pathology consisted of TCS with taut filum in 8 patients, conus lipoma with TCS in 7, diastematomyelia in 7, and cervical cord tethering in 2 patients. Of the 24 study patients, nondermatomal low-back or perineal pain occurred in 19 patients, bladder dysfunction in 21, and motor, sensory, and reflex abnormalities in 21 patients. Aggravating factors were repeated stretching, multiple pregnancies, heavy lifting, and repeated bending. Urological evaluation included bladder capacity, emptying, postvoid residuals, detrusor function, pelvic floor electromyography (EMG), bladder sensitivity, and sphincter EMG, which were repeated at 6 months and 1 year postoperatively. The follow-up was 1 to 30 years. Detailed postoperative neurological findings and separate patient outcome evaluations were recorded. Four of the 24 patients did not have an operation. RESULTS Resolution of pain occurred in 16 of the 19 patients reporting low-back or perineal pain. Motor and sensory complaints resolved in 17 of 20 patients. Regarding bladder dysfunction, in the 20 patients with available data, bladder function returned to normal in 12 patients, improved in 3 patients, and was unchanged in 5 patients. If the symptom duration was less than 6–8 months, there was recovery of all parameters of pain, bladder dysfunction, and neurological deficit, and recovery from hyperreflexia matched that from neurological deficit. Fifteen patients were employed preoperatively and returned to work, and an additional 3 others who were unable to work preoperatively were able to do so postoperatively. CONCLUSIONS Most adults with newly diagnosed TCS have unrecognized neurocutaneous abnormalities and neurological deficits. The triad of nondermatomal sacral or perineal pain, bladder dysfunction, and neurological deficit should not be confused with hip or degenerative lumbosacral disease. Addressing the primary pathology often leads to successful results.

Clinical analysis of tethered cord syndrome and gene expression profiling of wound healing surgery

“…Amongst patients referred to and treated by urologists and general practitioners, a small group of patients has undiagnosed TCS. This necessitates an MRI scan to detect the condition, which is not easy due to the rarity of the disease, especially in adulthood [27,28].…”

Dekyphosis operation combined with limited osteotomy to treat the symptomatic adult tethered cord syndrome with complicated malformations: A case report

“…Tethered cord syndrome is usually described as degenerating due to the abnormal fixation of the conus medullaris to the lower end of the spine for some reason, resulting in ischemia and hypoxia of the spinal cord. [10] Clinically, some patients will have symptoms of nerve damage such as lower limb weakness, numbness, small limbs, foot deformities, defecation, and urination disorders. [11] TCS mostly occurs in childhood.…”

Comparison of the electrophysiological characteristics of tight filum terminale and tethered cord syndrome

“…TCS spinal cord dysfunction is believed to be caused by pathological longitudinal stretching of the spinal cord 2 . Patients with TCS present with neurological symptoms, such as motor and sensory disturbances in the lower extremities, bladder and bowel dysfunction, and sexual dysfunction 3 . Some patients show neurological de cits similar to those of TCS despite normal location of the tips of the spinal cones.…”