Primary Tethered Cord Syndrome

Abstract

While tethered cord syndrome (TCS) has often been referred to as a single entity in the past, this view is beginning to change. Secondary forms like those associated with myelomeningocele, lipoma, or trauma may be entirely different from primary ones. Criteria that had been thought to be important, like low conus medullare, thick filum terminale, and permanent cord traction, are also now being questioned with respect to their contribution to the pathophysiology and to the clinical picture. Primary TCS may be entirely different from secondary forms related to trauma, myelomeningocele repair, or dysraphism in general. 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 recently widened rather than narrowed. Early diagnosis to prevent neurological deterioration is an urgent requirement, and even prophylactic surgery is now being advocated [2, 20, 59, 67]. On the other hand, there is evidence that a low conus and/or a thick filum do not necessarily lead to clinical symptoms typical for TCS [47, 56].