Diagnosis Of Tethered Cord Syndrome Research Articles

Growth profile assessment of young adults with tethered cord syndrome: a retrospective cohort analysis of Korean conscription data.

Tethered cord syndrome (TCS) is characterized by progressive spinal cord degeneration secondary to congenital spinal dysraphism. The associated accompanying physical inactivity and musculoskeletal deformities have raised interest in the growth profile of adult TCS patients. However, few previous studies have investigated the growth profile of adult TCS patients. We retrospectively reviewed the demographic data and medical records of 20-year-old Korean conscription examinees who were registered between April 2004 and September 2019. In total, 151 examinees with a diagnosis of TCS were enrolled. The height, weight, and body mass index (BMI) of 300 randomly selected examinees were compared to the TCS group. Obesity was defined by the World Health Organization and Asian-Pacific criteria for BMI and compared between the groups. Growth profile differences according to tethering location and musculoskeletal deformities were analyzed in both groups. The mean height, weight, and BMI values of the TCS group were lower than those of the control group. The TCS group had a lower proportion of obese and overweight individuals, and a higher proportion of underweight individuals, according to both BMI criteria. The tethering level was not associated with the degree of obesity in the tethered group. The mean height, weight, and BMI were lower in the tethered group regardless of the existence of musculoskeletal deformity. Enrollees with a history of TCS were smaller than controls of the same age. Monitoring of health behaviors, including nutrition, diet, and exercise, is warranted for TCS patients.

Urological Evaluation of Tethered Cord Syndrome.

To describe how to perform urological evaluation in children with tethered cord syndrome (TCS). Although a common manifestation of TCS is the development of neurogenic bladder in developing children, neurosurgeons often face difficulty in detecting urological problems in patients with TCS. From a urological perspective, diagnosis of TCS in developing children is further complicated due to the differentiation between neurogenic bladder dysfunctions and transient bladder dysfunctions owing to developmental problems. Due to the paucity of evidence regarding evaluation prior to and after untethering, I have shown the purpose and tools for evaluation in my own practice. This may be tailored to the types of neurogenic bladder, developmental status, and risks for deterioration. While the urodynamic study (UDS) is the gold standard test for understanding bladder function, it is not a panacea in revealing the nature of bladder dysfunction. In addition, clinicians should consider the influence of developmental processes on bladder function. Before untethering, UDS should reveal synergic urethral movement, which indicates an intact sacral reflex and lack of TCS. Postoperatively, the measurement of post-void residual urine volume is a key factor for the evaluation of spontaneous voiders. In case of elevation, fecal impaction, which is common in spinal dysraphism, should be addressed. In patients with clean intermittent catheterization, the frequency-volume chart should be monitored to assess the storage function of the bladder. Toilet training is an important sign of maturation, and its achievement should be monitored. Signs of bladder deterioration should be acknowledged, and follow-up schedule should be tailored to prevent upper urinary tract damage and also to determine an adequate timing for intervention. Neurosurgeons should be aware of urological problems related to TCS as well as urologists. Cooperation and regular discussion between the two disciplines could enhance the quality of patient care. Accumulation of experience will improve follow-up strategies.

Scoliosis may be the first symptom of the tethered spinal cord

Background:Tethered cord syndrome (TCS) is a progressive clinical entity that arises from abnormal spinal cord tension. Scoliosis may be a unique symptom in TCS. The aim of this study is to investigate prognosis after releasing the filum terminale in scoliosis due to TCS with/without findings in magnetic resonance imaging (MRI) and to draw attention to the importance of somatosensorial evoked potentials (SSEP) on the differential diagnosis of idiopathic scoliosis versus scoliosis due to TCS with normal appearance of filum terminale and conus medullaris.Materials and Methods:Eleven female and seven male patients with progressive scoliosis were included in the study. They were evaluated radiologically, SSEP and urodynamical studies. Preoperative and postoperative anteroposterior full spine X-rays were obtained for measuring the Cobb's angle. MRI was performed in all cases for probable additional spinal abnormalities. All patients underwent filum terminale sectioning through a L5 hemilaminectomy. The resected filum terminale were subjected to histopathological examination.Results:The mean Cobb angle was 31.6° (range 18°–45°). Eight patients (44.45%) had a normal appearance of filum terminale and normal level conus medullaris in MRI, but conduction delay and/or block was seen on SSEP. In the histopathological examination of filum terminale dense collagen fibers, hyaline degeneration and loss of elastic fibers were observed. Postoperatively none of the patients showed worsening of the Cobb angle. Three patients showed improvement of scoliosis.Conclusion:In TCS presented with scoliosis, untethering must be performed prior to the corrective spinal surgery. Absence of MRI findings does not definitely exclude TCS. SSEP is an important additional guidance in the diagnosis of TCS. After untethering, a followup period of 6 months is essential to show it untethering helps in stopping the progress of the scoliotic curve. In spite of non progression (curve stopped lesser than 45°) or even improvement of scoliosis, there may be no need for major orthopedic surgical intervention.

Management of adult tethered cord syndrome: our experience and review of literature.

Tethered cord syndrome (TCS) is a complex clinicopathologic entity, mostly described in children with limited number of studies describing in adults. This unique and rare subgroup of patients presents with characteristic features of TCS, but unlike children, pain is a predominant clinical symptom. Case records of 24 patients aged ≥16 years who had undergone surgery with a diagnosis of TCS between 2001 and 2011 were reviewed. Patients who have underwent surgery earlier for tethered cord or for diastematomyelia/spinal dysraphism and patients who had radiological evidence of tethering elements like lipoma of the cord on magnetic resonance imaging (MRI) were excluded from the study. Low backache was the most common presenting symptom. At the time of final follow-up, 15 (83.3%) patients had shown improvement in backache. Weakness improved by at least one grade in seven (77.8%) patients. Bladder symptoms improved in six (50%) patients. In case of symptomatic patient with low-lying cord, detethering is an advisable option.

Tethered cord syndrome: A study of 35 patients

Abstract Objectives Tethered cord syndrome (TCS) is a stretch-induced functional disorder of the spinal cord in which the caudal part is anchored by an inelastic structure. The majority of cases are related to spinal dysraphism. The presentations differ according to the underlying pathological condition and age, with pain, cutaneous signs, orthopedic deformities and neurological deficits being the commonest. Our aim was to determine the presentations in Saudi patients and to study the natural history of untreated late presenting cases. Methods This was a retrospective study of 35 consecutive Saudi patients with TCS seen at a single institution over a period of 7 years. The frequency and presentation of each type of spinal dysraphism and the natural history of untreated, late-presenting cases were studied. Results The most frequent spinal dysraphism associated with TCS was lipomeningomyelocele in 12 patients (34.3%), followed by TCS secondary to myelomeningocele in 8 patients (22.8%). Dermal sinus was found in 5 patients, diastematomyelia in 4 patients, meningocele in 3 patients and thick filum terminale in 3 patients. Thirteen patients out of 19 patients over 2 years of age (68.4%), presented with progressive neurological deficits. Conclusion Patients suspected of having TCS must be referred and treated by the age of 2 years, or soon after diagnosis, as they are likely to develop progressive neurological deficits if untreated. Normal radiology in the presence of clinical features of cord tethering should not exclude the diagnosis of TCS.

Management of recurrent adult tethered cord syndrome

Recurrent tethered cord syndrome (TCS) can lead to significant progressive disability in adults. The diagnosis of TCS is made with a high degree of clinical suspicion. In the adult population, many patients receive inadequate care unless they are seen at a multidisciplinary clinic. Successful detethering procedures require careful intradural dissection and meticulous wound and dural closure. With multiple revision procedures, vertebral column shortening has become an appropriate alternative to surgical detethering.

Study on the morphology and ultrastructure of fetus filum terminale

Objective The filum terminale(FT) plays an important role in the pathophysiology of tethered cord syndrome (TCS). The study on morphology and ultrastructure of fetus FT can provide reference standard for diagnosis of TCS . Method Eleven fresh human aborted fila fetuses had been measured and removed. Transversal and longitudinal sections of the middle, and distal thirds of FT were submitted to light microscopy analysis with four different techniques. Four ilia were selected for longitudinal and transversal scanning electron microscopy analysis. Results The bulk of the FT was composed of 1 μm to 5 μm thick spring like longitudinal bundles of collagen separated by 5 μm to 30 μm layer intervals and 1 μm to 5 μm intervals in the layer, although a small quantity of capillaries and other elements may be present. A delicate (0.13 μm) meshwork of collagen transversal fibers connects these bundles and fibers in every bundle. Collagen bundles could also be found between layers and bundles. Abundant longitudinally oriented elastic fibers were found inside or between collagen bundles. A complex tridimensional structure was evidenced on electron microscopy. Conclusions A complex tridimensional structure composed by ordered arrangement of spring like fibers and small quantity of capillaries should elicit considerable elastic properties to the FT. It's alternation of structure and element maybe involved closely in TCS. Key words: Filum terminale, fetus; Tethered cord syndrome; Anatomy

Tethered spinal cord following repair of myelomeningocele.

The goal of this paper is to elucidate the clinical presentation of tethered cord syndrome (TCS) following repair of a myelomeningocele. Approximately 10 to 30% of children will develop TCS following repair of a myelomeningocele. Because essentially all children with repaired myelomeningocele will have a tethered spinal cord, as demonstrated on MR imaging, the diagnosis of TCS is made based on clinical criteria. The six common clinical presentations of TCS are increased weakness (55%), worsening gait (54%), scoliosis (51%), pain (32%), orthopedic deformity (11%), and urological dysfunction (6%). The primary goal of surgery is to detach the spinal cord where it is adherent to the thecal sac, relieving the stretch on the terminal portion of the cord. Early diagnosis and surgical release of the tethered cord results in stabilization or improvement in most cases. Because TCS may present with orthopedic and/or urological signs or symptoms, children with myelomeningocele should by followed, ideally in a multidisciplinary clinic, by neurosurgeons, orthopedic surgeons, and urologists who are aware of this condition.