Abstract
Tethered cord syndrome (TCS) is a clinical condition of multiple etiologies that occurs when an anchoring element results in the conus medullaris lying at a position lower than normal, leading to neurologic, urologic, and musculoskeletal deterioration. Patients with progressive symptoms related to the TCS, as well as asymptomatic patients at high or unpredictable risk of progression weighed against the surgical risk, should undergo detethering. X-ray and/or computed tomography (CT) scan are used to detect vertebral anomalies, and magnetic resonance imaging (MRI) of the entire neuroaxis identifies the conus and the tethering element, if present, and detects any associated central nervous system (CNS) anomalies. A multidisciplinary approach may be necessary in complex cases. Intraoperative neuromonitoring with direct nerve root stimulation is highly recommended in cases of complex lipomas. The surgical steps depend on the tethering pathology (lipomyelomeningocele, fatty filum terminale, diastematomyelia, myelocystocele, epidermoid/dermoid/neurenteric cyst, dermal sinus tract).
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