Tethered Spinal Cord: Update of an Analysis of Published Articles

Gs, Liptak

doi:10.1055/s-2008-1066257

Cited by 20 publications

(7 citation statements)

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“…The arguments for prophylactic untethering are that: (1) a certain (undefined) percentage of these patients will go on to develop symptomatic TCS; (2) one cannot guarantee reversibility of symptoms, even with prompt surgery, and (3) the morbidity for filum sectioning is reasonably low. For these reasons, some authors advocate strongly for prophylactic untethering[ 54, 79, 80], while others remain skeptical[ 37, 81]. Although widely practiced, the beneficial effect of prophylactic untethering in asymptomatic patients remains to be proven by controlled, prospective studies.…”

Section: Miscellaneous Topicsmentioning

confidence: 99%

Tethered Cord Syndrome: An Updated Review

2007

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Tethered cord syndrome (TCS) is a diverse clinical entity characterized by symptoms and signs which are caused by excessive tension on the spinal cord. The majority of cases are related to spinal dysraphism. TCS can present in any age group, and presentations differ according to the underlying pathologic condition and age, with pain, cutaneous signs, orthopedic deformities and neurological deficits being the most common. Surgical untethering is indicated in patients with progressive or new onset symptomatology attributable to TCS. The surgical strategy aims to release the tethering structure and thus the chronic tension on the cord. Early operative intervention is associated with improved outcomes. Pain relief is accomplished in almost all cases. Realistic surgical goals include relief of pain and stabilization of neurological function, although improvement in function is often seen. Cord untethering can also halt the progression of scoliosis. The benefits of surgery are debated in asymptomatic patients and patients with normal imaging.

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Section: Miscellaneous Topicsmentioning

confidence: 99%

Tethered Cord Syndrome: An Updated Review

2007

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“…It is also well established that pre-existing sphincter and motor dysfunction have only a small chance of improving with surgical untethering [6, 10, 11, 12]. Controversy still exists regarding prophylactic surgery and its timing in asymptomatic cases [7, 9, 14, 15]. More recent studies have indicated some effectiveness of prophylactic surgery for spinal lipomas in early childhood [5, 6, 7, 9, 16, 17, 18].…”

Section: Introductionmentioning

confidence: 99%

“…More recent studies have indicated some effectiveness of prophylactic surgery for spinal lipomas in early childhood [5, 6, 7, 9, 16, 17, 18]. Ethical considerations have precluded randomized prospective study of the efficacy of surgical treatment [14]. …”

Section: Introductionmentioning

confidence: 99%

Spinal Lipomas in Children

et al. 2000

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Spinal cord lipomas are a common cause of cord tethering that can lead to progressive neurological defects. The role of prophylactic surgery for spinal lipomas has recently been questioned. Between 1985 and 1999, 59 children underwent a total of 69 surgical procedures at the Birmingham Children’s Hospital in Birmingham, UK. The spinal lipomas were classified into: 18 terminal, 17 transitional, 6 dorsal and 18 filum lipomas – including 12 who had a typical thickened filum terminale. At the first operation, 19 patients (32%) were asymptomatic, and 40 patients (68%) presented with symptoms. Surgical indications in the asymptomatic group included the presence of a dermal sinus tract or syrinx. Prophylactic surgery was undertaken in selected cases. The mean total follow-up for the group since the first surgical procedure was 61.8 months (range: 7.0–203.0 months). In the asymptomatic group, 26% of the patients had late neurological deterioration. Of the 14 patients with asymptomatic conus lipomas, 3 (21%) developed sphincter dysfunction and motor problems at long-term follow-up. In the symptomatic group, 68% improved, 20% remained unchanged, and 12% had late neurological deterioration. None of the 18 patients with symptomatic filum lipoma deteriorated postoperatively. However, 39% had bladder dysfunction, 54% had neuro-orthopaedic deformity, and only 15% returned to overall normal function at latest follow-up. Of the 27 patients with symptomatic conus lipomas, 67% improved, 15% remained stable, and 18% had late neurological deterioration. However, 74% had bladder dysfunction, 67% had neuro-orthopaedic deformity, and 45% had motor problems at long-term follow-up. Spinal lipomas can cause progressive neurological deficits irrespective of spinal untethering surgery. This study demonstrates that filum and conus lipomas have similar clinical presentation, but differ in their outcome following surgery. Filum lipomas are ‘benign’, for which surgery is safe and effective. Conus lipomas are more difficult to manage. When asymptomatic, our results suggest that prophylactic surgery does provide some protection from future neurological deterioration. When symptomatic, conus lipoma surgery is effective in stopping further deterioration. Improvement in neurological function can occur, but few patients return to normal overall function, and pre-existing sphincter dysfunction is not significantly altered by surgery.

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“…We reviewed 215 papers published between 1943-1994 addressing the issue of tethered spinal cord [Liptak, 1992[Liptak, , 1995. Valid and generalizable conclusions were difficult to draw from these studies because of severe methodological problems.…”

Section: Tethered Spinal Cordmentioning

confidence: 99%

Controversies in the treatment of neural tube defects with neurological deterioration

Liptak¹

1998

Ment. Retard. Dev. Disabil. Res. Rev.

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Tethered Spinal Cord: Update of an Analysis of Published Articles

Cited by 20 publications

References 0 publications

Tethered Cord Syndrome: An Updated Review

Tethered Cord Syndrome: An Updated Review

Spinal Lipomas in Children

Controversies in the treatment of neural tube defects with neurological deterioration

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