Clinico pathological study of tethered cord syndrome

Abstract

Background: The disorder remains a challenge for both diagnostic and therapeutic measures. Today there is no question, however, that neurosurgery plays an important role in its treatment and indications for surgery have now widened rather than narrowed. Early diagnosis to prevent neurological deterioration is an urgent requirement. The objective of the study was, the current study focuses on tethered cord syndrome by age group, of the more common causes of the condition, as well as the adult presentation of occult TCS, its presentation and management. Methods: This is a prospective study conducted on 44 patients who presented to outpatient department of Neurosurgery, Osmania Medical College/Hospital, Hyderabad between August 2011 to February 2014. All the patients were diagnosed based on clinical features investigations like X-ray spine and brain screening apart from routine investigations to assess fitness for surgery. All patients were counseled regarding the diagnosis, its treatment options, possible complications including intra operative bleeding, infection, cerebrospinal fluid leak/fistula formation, wound dehiscence, possibility of improvement, worsening, persistence of symptoms, retethering of cord and after obtained informed consent were included in the study and subjected to surgery. Results: Infants (<1 year) are the most common age group of presentation as was observed in other series. There is no significant difference in incidence of tethered cord syndrome among males or females with a slight inclination towards males as was observed in other studies. Swelling over lower back with associated cutaneous lesion since birth are the most common presentations among children. Neurological deficits, bladder incontinence, bone deformities associated with tethering are commonly seen in elderly children or adults presenting late and do not subside / improve easily once they set in. Primary Tethered cord syndrome is more common than acquired. Back pain is generally a feature of presentation in elderly children and adults and probably the only symptom which subsides after detethering. Conclusions: MRI is the best diagnostic tool for identification of tethering and associated anomalies. Myelomeningocele and Lipomyelomeningocele are the most common associated anomalies with tethered cord syndrome. Proper identification of filum terminale, arachnoid bands and rootlets by electrophysiological monitoring intra operatively and good anatomical knowledge and proper establishment of CSF flow are essential for preventing retethering.