Cord Syndrome In Patients Research Articles

The Central Cord Syndrome in Patients with Cervical Spinal Cord Tumors: A 19th-Century Vignette from (Karl) Julius Vogel (1814-1880).

Between 1830 and 1850, (Karl) Julius Vogel was one of the most important German pathologists. He received his doctorate in medicine in 1838 from the University of Munich and habilitation in pathology in 1840. In 1846, he moved to the University of Giessen as a full professor of pathology. From 1855, he taught special pathology and therapy at the University of Halle and became director of the internal clinic. Vogel and Heinrich Adolph Karl Dittmar were the first clinicians to describe the symptoms and pathologic findings of the central cord syndrome in a cervical spine tumor.

Prognostic and risk factors for the surgical efficacy of central spinal cord syndrome in patients with preexisting degenerative cervical spinal cord compression.

To analyze the prognostic and risk factors related to surgical treatment of central spinal cord syndrome (CSS) and to find out the optimal timing of operative management. From January 2011 to January 2019, a consecutive series of 128 patients with CSS confirmed by magnetic resonance imaging (MRI) were retrospectively analyzed including their clinical records and radiologic data from a prospectively maintained database in a single center. According to the prognosis evaluated by the modified Japanese Orthopedic Association (mJOA), American Spinal Injury Association (ASIA) motor score (AMS), and ASIA impairment scale (AIS) grade, the overall postoperative outcome was good. Finally, it was found that surgical timing, presence of myelopathy or not at baseline, AMS at admission, and compression ratio were independent factors affecting the prognosis. Surgery as soon as possible after the occurrence of CSS is still advocated. Cervical myelopathy at baseline, compression ratio, and AMS score on admission were independent prognostic factors for the surgical treatment of CSS. If surgical indications are clear, early surgical intervention should be actively considered.

Assessment of MRI and Ultrasound Screening for Tethered Cord Syndrome in Patients Diagnosed With Esophageal Atresia/Tracheoesophageal Fistula

IntroductionInfants with esophageal atresia and/or tracheoesophageal fistula (EA/TEF) undergo screening for tethered cord syndrome (TCS) via ultrasound and magnetic resonance imaging. Existing literature lacks data to guide optimal timing of screening and magnetic resonance imaging (MRI) is often delayed until 3-6 mo of age, when it is frequently forgotten. Detethering surgery has a high rate of success in patients with TCS and is often performed prophylactically due to potential irreversible deficits. This study aims to improve screening procedure for infants with EA/TEF. MethodsA retrospective chart review was done of all EA/TEF patients treated over 6 y (n = 79). The study examined how often each imaging modality was performed and identified a TCS lesion, as well as age of screening/surgical intervention. ResultsScreening for TCS was done with MRI 58% of the time and US 15% of the time. However, 38% of patients did not undergo any screening. Out of the patients with TCS on MRI (n = 19, 41.3%), 73.7% had neurosurgery. Of patients who underwent ultrasound (US) (n = 12), nine patients also had MRI later: two reported TCS lesions and subsequently had neurosurgery. Surgical infection rates and complications were 0/14. ConclusionsMRI demonstrated a higher rate of detecting TCS lesions than US, and patients with TCS frequently had detethering. Patients with ≥3 VACTERL or vertebral anomalies had a higher incidence of TCS on MRI. Patients with vertebral anomalies reported false negative ultrasounds in two cases, suggesting the potential superiority of MRI screening in this subgroup. A third of children did not undergo any imaging and this will require a process improvement.

The incidence and effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele: a population-based study.

The goal of this study was to establish an incidence and assess the effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele. The study population was based on the Western Denmark Myelomeningocele Database, which contains all patients born with myelomeningocele in western Denmark since 1970. The study population was cross-referenced in 2015 with a database for surgical procedures containing all surgical procedures performed in the central Denmark region since 1996. Patients alive between 1996 and 2015 were identified. Incidences was calculated and presented for year of age. File reviews were conducted for all patients who underwent the procedure. Follow-up was divided into short-term and long-term follow-up. One hundred sixty-six patients were alive during various time periods between 1996 and 2015. Of these, 45 patients underwent the procedure. Seven underwent reoperation. The median age for the procedure was 12 years and the highest incidence was found at 15 years of age. Incidence was bimodal with highest incidence in children and adolescents. The most common indications were progressive spine deformity (40%), deteriorating ambulation (38%), and deteriorating neurogenic bladder and/or bowel dysfunction (32%). The mean short-term follow-up was 4.7 months and the mean long-term follow-up was 72.6 months. Postoperatively, the majority had improved (27%) or stabilized (27%) at short-term follow-up. At long-term follow-up, most patients were stable (27%) or had deteriorated (24%). For both follow-up terms there was a loss of approximately one-third of all patients. Complications occurred in 17% of the procedures. In this population-based study, tethered cord release has the highest incidence in children and adolescents. The beneficial effect of the procedure seems to be short term. Due to the uncertainty of a long-term effect of the procedure in patients with myelomeningocele and the registered complications, the authors suggest that this surgical indication should be reserved for well-selected patients.

Dynamic magnetic resonance imaging parameters for objective assessment of the magnitude of tethered cord syndrome in patients with spinal dysraphism.

Dynamic magnetic resonance imaging (MRI)-based criteria for diagnosing magnitude of tethered cord syndrome (TCS) in occult spinal dysraphism are proposed. In this prospective, case-control design study, MRI lumbosacral spine was performed in 51 subjects [pilot group (n = 10) without TCS (for defining radiological parameters), control group (n = 10) without TCS (for baseline assessment), and study group (n = 31) with spinal dysraphism (thick filum terminale [n = 12], lumbar/lumbosacral meningomyelocoele [n = 6], and lipomyelomeningocoele [n = 13])]. The parameters compared in control and study groups included oscillatory frequency (OF), difference in ratio, in supine/prone position, of distance between posterior margin of vertebral body and anterior margin of spinal cord (oscillatory distance [OD]), with canal diameter, at the level of conus as well as superior border of contiguous two vertebrae above that level; delta bending angle (ΔBA), difference, in supine/prone position, of angle between longitudinal axis of conus and that of lower spinal cord; and sagittal and axial root angles, subtended between exiting ventral nerve roots and longitudinal axis of cord. An outcome assessment at follow-up was also done. In the study group (cord tethered), significantly less movement at the level of conus (OF0, p = 0.013) and one level above (OF1, p = 0.03) and significant difference in ΔBA (p = 0.0) were observed in supine and prone positions, compared to controls. Ventral nerve root stretching resulted in sagittal/axial root angle changes. Median OF (0.04) in the lipomyelomeningocoele group was significantly less than that in control group (0.23). Median OF was also lesser in patients with thick filum terminale or meningomyelocele. Difference in median sagittal and axial root angles among the study and control groups was statistically significant (p = 0.00). New dynamic MRI-based parameters to establish the presence and magnitude of TCS have been defined. OF measured the extent of loss of translational cord displacement in supine and prone positions; ΔBA defined the relative angulation of conus with lower spinal cord, and sagittal and axial root angles represented ventral nerve root stretching. The difference in OF or ΔBA was minimum in the group with thick filum terminale and progressively increased in the groups with lipomyelomeningocele and meningomyelocele.

131 Dynamic Magnetic Resonance Imaging Parameters for Objective Assessment of the Magnitude of Tethered Cord Syndrome in Patients With Spinal Dysraphism

131 Dynamic Magnetic Resonance Imaging Parameters for Objective Assessment of the Magnitude of Tethered Cord Syndrome in Patients With Spinal Dysraphism

Secondary tethered cord syndrome in patients with myelomeningocele

Myelomeningocele is associated with other neurological abnormalities, including hydrocephalus, Chiari II malformations, syringomyelia, and secondary tethered cord syndrome. Tethered cord syndrome occurs because of abnormal attachment of the spinal cord to the caudal dural sac, causing cord ischemia. Occasionally, symptoms of progressive neurological deterioration may occur and can significantly affect the long-term outcome of these patients. Proper management of patients with myelomeningocele requires long-term follow-up and evaluation of signs of neurological deterioration that suggest secondary tethered cord syndrome. Treatment of these patients may target symptoms, such as urological intervention for bladder dysfunction, or it may target the tethered cord itself. Recently, many studies have shown that tethered cord release can significantly improve symptoms in these patients.

Central Cord Syndrome in Patients With Klippel-Feil Syndrome Resulting From Winter Sports: Report of 3 Cases

Central Cord Syndrome in Patients With Klippel-Feil Syndrome Resulting From Winter Sports: Report of 3 Cases

Central Cord Syndrome in Patients with Klippel-Feil Syndrome Resulting from Winter Sports

Central Cord Syndrome in Patients with Klippel-Feil Syndrome Resulting from Winter Sports

Adult tethered cord syndrome in patients with postrepair myelomeningocele: an evidence-based outcome study

Object. As patients with myelomeningocele age, tethered cord syndrome (TCS) in adults with postrepair myelomeningocele has become more common. The authors have structured an evidence-based review of the literature for the purpose of addressing the following questions. 1) How is the diagnosis made? 2) What is the natural history that occurs in adults with postrepair myelomeningocele and TCS? 3) What are the criteria for operative intervention? 4) What is the functional outcome for patients with postrepair myelomeningocele? Methods. A computerized search of the National Library of Medicine of the English-language literature published from 1966 to 2003 was performed. Articles pertaining to the clinical aspects and management of postrepair myelomeningocele in adults, TCS in adults resulting from closed defects, and pediatric patients with postrepair myelomeningocele were reviewed. No Level 1 or 2 data were located; however, the search yielded Level 3 and 4 evidence in the literature in which the clinical syndrome, underlying pathology, and the imaging and electrophysiological evaluation for TCS in adults are discussed. Conclusions. Analysis of the available data indicates the following. 1) A lower lesion level predisposes patients to symptomatic tethering; moreover, orthopedic and urological deterioration will occur in the majority of these patients. 2) Tethered cord release should be considered for adult patients with postrepair myelomeningocele when clinical symptoms, imaging studies, urodynamics, and somatosensory evoked potentials are consistent with TCS. 3) Prompt, aggressive untethering surgery within 5 years of symptom onset, along with long-term follow up to check for delayed retethering, is recommended. The overall outcome for patients with postrepair myelomeningocele may not be as good as the outcome for adults with closed dysraphism.

Adult tethered cord syndrome in patients with postrepair myelomeningocele: an evidence-based outcome study

As patients with myelomeningocele age, tethered cord syndrome (TCS) in adults with postrepair myelomeningocele has become more common. The authors have structured an evidence-based review of the literature for the purpose of addressing the following questions. (1) How is the diagnosis made? (2) What is the natural history that occurs in adults with postrepair myelomeningocele and TCS? (3) What are the criteria for operative intervention? (4) What is the functional outcome for patients with postrepair myelomeningocele? A computerized search of the National Library of Medicine of the English-language literature published from 1966 to 2003 was performed. Articles pertaining to the clinical aspects and management of postrepair myelomeningocele in adults, TCS in adults resulting from closed defects, and pediatric patients with postrepair myelomeningocele were reviewed. No Level 1 or 2 data were located; however, the search yielded Level 3 and 4 evidence in the literature in which the clinical syndrome, underlying pathology, and the imaging and electrophysiological evaluation for TCS in adults are discussed. Analysis of the available data indicates the following. (1) A lower lesion level predisposes patients to symptomatic tethering; moreover, orthopedic and urological deterioration will occur in the majority of these patients. (2) Tethered cord release should be considered for adult patients with postrepair myelomeningocele when clinical symptoms, imaging studies, urodynamics, and somatosensory evoked potentials are consistent with TCS. (3) Prompt, aggressive untethering surgery within 5 years of symptom onset, along with long-term follow up to check for delayed retethering, is recommended. The overall outcome for patients with postrepair myelomeningocele may not be as good as the outcome for adults with closed dysraphism.

Tethered cord syndrome and the conus in a normal position.

The intent of this article is to propose the existence of the tethered cord syndrome in patients whose conus is in a normal position. The tethered cord syndrome has been a well-recognized entity, occurring in the pediatric and adult population. A central tenet to this syndrome is that the conus medullaris must be "abnormally" low, regardless of the tethering lesion. Our 12-year series of 73 patients with tethered cord syndrome included 13 patients in whom the cord terminated at or above the L1-L2 space. These patients otherwise displayed characteristics usually associated with the patient with an abnormally low conus. Most patients with progressive neurological deterioration responded to surgery. The preoperative radiographic evaluation and the operative findings usually demonstrated a thickened filum. Tethered cord syndrome may occur in the patient who has a conus in the "normal" position.

Tethered cord syndrome of delayed onset following repair of myelomeningocele.

Nine (15%) of 60 patients with repaired myelomeningocele exhibited late deterioration of neurological function with a tethered cord syndrome. Dense adhesions at the lowest laminae and at the site of previous repair were the most common findings at surgery. Postoperatively, 71% of the patients improved. Magnetic resonance (MR) imaging was performed in 29 of the 60 patients. Eight of these 29 patients exhibited a tethered cord syndrome. The MR images in all patients showed a low-lying conus fixed at the site of previous repair, irrespective of the presence or absence of a tethered cord syndrome. The MR images were classified into two groups depending upon the site of adhesions: Group A had potential sites of tethering at the ventral aspect of the last laminae and at the site of previous repair, and Group B showed the adhesion point only at the site of previous repair. Most patients with a tethered cord syndrome were found to be in Group A; conversely, most patients without the syndrome were in Group B. An enlarged low conus was seen in symptomatic patients more commonly than in those without this syndrome. It is concluded that the presence of adhesions specifically at the last laminae as well as a widened low-lying conus may be the cause of tethered cord syndrome in patients with repaired myelomeningoceles. A clear understanding of the tethering process and preoperative evaluation of potential sites of tethering, based on the MR findings, are very important for planning surgery. The release of adhesions at the lowest laminae by laminectomy appeared essential for improvement.