Tethered Cord Syndrome in the Pediatric-Adolescent Gynecologic Patient

Abstract

BackgroundTethered Cord Syndrome (TCS) is caused by abnormal tissue attachments of the spinal cord that limit its movement in the canal and produce stretching in the cord. It encompasses a clinical spectrum of signs and symptoms including urinary and bowel incontinence, gait abnormalities, lower extremity or pelvic pain, limb weakness, and various motor and sensory defects. Our primary objective is to establish data on how pediatric and adolescent patients may present to the gynecologist when they have TCS. Our secondary aim is to investigate their outcomes, need for surgical intervention and postoperative resolution of symptoms.MethodsUpon IRB approval, 10 children with TCS have been identified from a single Pediatric and Adolescent Gynecology clinic (PAGC) between January 2005 and October 2012. Clinical outcomes, need for surgical intervention and postoperative resolution of symptoms are being evaluated.ResultsThis study represents a continuation and expansion of the only case series (n=5) on TCS in Pediatric and Adolescent Gynecology that was presented as a poster but never completed for publication. We have identified 10 additional patients for review, and preliminary data shows that the mean age of TCS was 13.3 years (range 6-24 years). All patients were Caucasian (100%) and all of them were symptomatic after a thorough review of system; the most common symptom found was urinary incontinence (UI) (80%). All MRI were ordered from the PAGC, UI was most common reason to order it, and a normal MRI was the most common finding. All patients were referred to Neurosurgery, (N=9) underwent De-Tethering procedure, and 75% had complete resolution of symptoms. The remaining 25% had great improvement of symptoms.ConclusionsTethered Cord Syndrome is caused by increased tension on the spinal cord from a variety of etiologies. The clinical course is characterized by a progression of both motor and sensory nerve deficits, some of which may present with symptoms revealed only on a thorough review of systems. As many of this patients may be seen by Pediatric and Adolescent Gynecology, as part of their work up, it is important for clinicians to maintain a high index of suspicion for TCS in patients with unexplained incontinence, pelvic pain or gait abnormalities that are refractory to other medical therapy, even if the MRI is normal. As the disease is believed to be mediated by oxidative metabolic changes and local ischemia to the cord, early diagnosis is crucial to prevent permanent neurologic sequelae. Once our review is complete, we will present the most common complaints and clinical findings to help guide providers to evaluate for TCS in the Pediatric and Adolescent Gynecology population. This study represents original work, and has not been previously presented or published. BackgroundTethered Cord Syndrome (TCS) is caused by abnormal tissue attachments of the spinal cord that limit its movement in the canal and produce stretching in the cord. It encompasses a clinical spectrum of signs and symptoms including urinary and bowel incontinence, gait abnormalities, lower extremity or pelvic pain, limb weakness, and various motor and sensory defects. Our primary objective is to establish data on how pediatric and adolescent patients may present to the gynecologist when they have TCS. Our secondary aim is to investigate their outcomes, need for surgical intervention and postoperative resolution of symptoms. Tethered Cord Syndrome (TCS) is caused by abnormal tissue attachments of the spinal cord that limit its movement in the canal and produce stretching in the cord. It encompasses a clinical spectrum of signs and symptoms including urinary and bowel incontinence, gait abnormalities, lower extremity or pelvic pain, limb weakness, and various motor and sensory defects. Our primary objective is to establish data on how pediatric and adolescent patients may present to the gynecologist when they have TCS. Our secondary aim is to investigate their outcomes, need for surgical intervention and postoperative resolution of symptoms. MethodsUpon IRB approval, 10 children with TCS have been identified from a single Pediatric and Adolescent Gynecology clinic (PAGC) between January 2005 and October 2012. Clinical outcomes, need for surgical intervention and postoperative resolution of symptoms are being evaluated. Upon IRB approval, 10 children with TCS have been identified from a single Pediatric and Adolescent Gynecology clinic (PAGC) between January 2005 and October 2012. Clinical outcomes, need for surgical intervention and postoperative resolution of symptoms are being evaluated. ResultsThis study represents a continuation and expansion of the only case series (n=5) on TCS in Pediatric and Adolescent Gynecology that was presented as a poster but never completed for publication. We have identified 10 additional patients for review, and preliminary data shows that the mean age of TCS was 13.3 years (range 6-24 years). All patients were Caucasian (100%) and all of them were symptomatic after a thorough review of system; the most common symptom found was urinary incontinence (UI) (80%). All MRI were ordered from the PAGC, UI was most common reason to order it, and a normal MRI was the most common finding. All patients were referred to Neurosurgery, (N=9) underwent De-Tethering procedure, and 75% had complete resolution of symptoms. The remaining 25% had great improvement of symptoms. This study represents a continuation and expansion of the only case series (n=5) on TCS in Pediatric and Adolescent Gynecology that was presented as a poster but never completed for publication. We have identified 10 additional patients for review, and preliminary data shows that the mean age of TCS was 13.3 years (range 6-24 years). All patients were Caucasian (100%) and all of them were symptomatic after a thorough review of system; the most common symptom found was urinary incontinence (UI) (80%). All MRI were ordered from the PAGC, UI was most common reason to order it, and a normal MRI was the most common finding. All patients were referred to Neurosurgery, (N=9) underwent De-Tethering procedure, and 75% had complete resolution of symptoms. The remaining 25% had great improvement of symptoms. ConclusionsTethered Cord Syndrome is caused by increased tension on the spinal cord from a variety of etiologies. The clinical course is characterized by a progression of both motor and sensory nerve deficits, some of which may present with symptoms revealed only on a thorough review of systems. As many of this patients may be seen by Pediatric and Adolescent Gynecology, as part of their work up, it is important for clinicians to maintain a high index of suspicion for TCS in patients with unexplained incontinence, pelvic pain or gait abnormalities that are refractory to other medical therapy, even if the MRI is normal. As the disease is believed to be mediated by oxidative metabolic changes and local ischemia to the cord, early diagnosis is crucial to prevent permanent neurologic sequelae. Once our review is complete, we will present the most common complaints and clinical findings to help guide providers to evaluate for TCS in the Pediatric and Adolescent Gynecology population. This study represents original work, and has not been previously presented or published. Tethered Cord Syndrome is caused by increased tension on the spinal cord from a variety of etiologies. The clinical course is characterized by a progression of both motor and sensory nerve deficits, some of which may present with symptoms revealed only on a thorough review of systems. As many of this patients may be seen by Pediatric and Adolescent Gynecology, as part of their work up, it is important for clinicians to maintain a high index of suspicion for TCS in patients with unexplained incontinence, pelvic pain or gait abnormalities that are refractory to other medical therapy, even if the MRI is normal. As the disease is believed to be mediated by oxidative metabolic changes and local ischemia to the cord, early diagnosis is crucial to prevent permanent neurologic sequelae. Once our review is complete, we will present the most common complaints and clinical findings to help guide providers to evaluate for TCS in the Pediatric and Adolescent Gynecology population. This study represents original work, and has not been previously presented or published.