Tethered Cord Syndrome Research Articles

Filum terminale transection in pediatric tethered cord syndrome: a single center, population-based, cohort study of 95 cases

PurposeThe purpose of this study was to evaluate outcome following surgical transection of filum terminale (FT) in symptomatic and asymptomatic pediatric patients with radiological findings consistent with tethered cord syndrome (TCS).MethodsPatients < 17 years who underwent untethering surgery between 2007 and 2018 were screened for eligibility. Those who had undergone primary transection of the FT, and had preoperative radiological findings of fatty filum, thickened FT, or low-lying conus, below the pedicles of L2, were included. The cohort was divided into symptomatic and asymptomatic depending on clinical presentation. Surgical complications and functional outcome was recorded.ResultsIn total, 95 patients were included, of whom 62 were symptomatic. In symptomatic patients, the main indications for radiological evaluation were scoliosis (29%) and motor symptoms (19%). In asymptomatic patients, skin stigmata (76%) were the most common finding. Fatty or thick FT was the most common radiographic finding, seen in 61% of symptomatic and 79% of asymptomatic cases. All patients underwent transection of the FT and were followed for a median of 1.8 years. A postoperative complication occurred in 12%, all Ibanez type Ib and managed without invasive treatment. For the symptomatic cohort, significant improvement was seen for both urodynamic assessment (48% improved, p = 0.002) and sensorimotor function (42% improved, p < 0.001).ConclusionsNeurological improvement or halted deterioration was seen in the majority of symptomatic cases. Asymptomatic patients did not experience any severe complications. Filum transection should be offered to symptomatic and asymptomatic patients upon diagnosis of fatty filum, thickened FT, or low-lying conus.

Estimating the prevalence of neurosurgical interventions in adults with spina bifida using the Health Facts data set: implications for transition planning and the development of adult clinics.

As the care of patients with spina bifida continues to evolve, life expectancy is increasing, leading to a critical need for transition planning from pediatric-based to adult-based care. The burden of neurosurgical care for adults with spina bifida remains unknown. In this study, the authors sought to use a large national data set to estimate the prevalence of neurosurgical interventions in adults with spina bifida. This study utilized Health Facts, which is a de-identified proprietary data set abstracted from all Cerner electronic health records. It includes 69 million unique patients with > 500 million encounters in 580 centers. Validation, technical exclusions, and data filters were applied to obtain an appropriate cohort of patients. The ICD-9 and ICD-10 codes for all types of spinal dysraphism, as well as the Current Procedural Terminology (CPT) codes for hydrocephalus procedures, spinal cord untethering, and Chiari decompression, were queried and records were retrieved. Demographic variables along with differences in age groups and temporal trends were analyzed. Overall, 24,764 unique patients with ≥ 1 encounter with a spinal dysraphism diagnosis between 2000 and 2017 were identified. The pediatric cohort included 11,123 patients with 60,027 separate encounters, and the adult cohort included 13,641 patients with 41,618 separate encounters. The proportion of females was higher in the adult (62.9%) than in the pediatric (51.4%) cohort. Annual encounters were stable from 2 to 18 years of age, but then decreased by approximately half with a precipitous drop after age 21 years. The sex distribution of adults and children who underwent procedures was similar (54.6% female adults vs 52.4% female children). Surgical interventions in adults were common. Between 2013 and 2017, there were 4913 procedures for hydrocephalus, with 2435 (49.6%) adult patients. Similarly, 273 (33.3%) of the 819 tethered cord procedures were performed in adults, as were 307 (32.9%) of 933 Chiari decompressions. The Health Facts database offered another option for studying care delivery and utilization in patients aging with spina bifida. The median age of this population has now reached early adulthood, and a significant number of neurosurgical procedures were performed in adults. An abrupt drop in the rate of encounters occurred at 21 years of age, possibly reflecting transition issues such as access-to-care problems and lack of coordinated care.

Embryopathological relationship between retained medullary cord and caudal spinal lipoma

PurposeRetained medullary cord (RMC) is a condition in which the cord-like structure (C-LS) is continuous from the conus and extends to the dural cul-de-sac, causing spinal cord tethering, which is thought to originate from the secondary neurulation failure. Although diagnostic criteria for RMC have not yet been fully established, the following three items are generally considered important: (1) Typical morphological features on neuroimaging and intraoperative view. (2) The electrophysiological border between the conus and C-LS. (3) Ependyma-lined canal with surrounding neuroglial tissues (E-LC w/NGT) on histopathological examination of C-LS. To clarify the differences with caudal lipoma, which are also considered to be secondary neurulation disorders, in their embryological backgrounds, the clinicopathophysiological findings were compared. MethodsFive patients with RMC and 11 with caudal lipomas participated in this study. ResultsAll five patients with RMC naturally satisfied all three items. Four patients histopathologically showed a small amount of fibroadipose tissue. Regarding the first item in caudal lipoma, neuroimages demonstrated C-LS running parallel with or in the lipoma in all patients. In terms of the second item, the electrophysiological border was identified in 3 out of 4 patients in whom a sufficient operative field was obtained. Concerning the third item, E-LC w/NGT was noted in 6 of 7 patients in whom the lipoma was resected as a column. Areas of fibroadipose tissue histopathologically accounted for more than half of the total area. ConclusionThe caudal lipomas fulfilled most of the three items, and the only prominent difference between these two is the difference in the proportions of fibroadipose and fibrocollagenous tissues. These findings provide further evidence for the idea that RMC and caudal lipoma can be considered consequences of a continuum of regression failure during secondary neurulation, and it may not be possible to distinguish between the two clearly.

Diseased Filum Terminale as a Cause of Tethered Cord Syndrome in Ehlers-Danlos Syndrome: Histopathology, Biomechanics, Clinical Presentation, and Outcome of Filum Excision

Patients with hypermobile Ehlers-Danlos syndrome (hEDS), a heritable connective tissue disorder, present frequently with symptoms of tethered cord syndrome (TCS) but without a low-lying conus. Currently, surgical treatment of such cases is controversial. Because connective tissue disorder affects fibrous structures, we hypothesized that a diseased filum terminale (FT) might cause TCS in hEDS, justifying surgical transection for treatment. We investigated FT pathology, FT biomechanics, clinical presentation, and outcome following FT excision in 78 radiologically occult hEDS-TCS cases and for comparison in 38 typical TCS cases with low-lying conus and/or fatty FT infiltration but without hEDS. In hEDS-TCS, electron microscopy revealed inherited collagen fibril abnormalities and acquired fibril damage. Biomechanical tension tests revealed elastic properties of the FT in both study groups, but they were impaired in the hEDS TCS. Follow-up examinations at 3 and 12 months after FT excision showed statistically significant improvement of urinary, bowel, and neurologic symptoms in both study groups; intergroup comparison revealed no differences in outcome except more pronounced neurologic improvement in the hEDS-TCS group. Both morphologic findings and biomechanical tests indicate limited elastic properties of the FT in hEDS, which is no more able to dampen but still transmitting spine movement-related stretch forces. That mechanism exposes the conus medullaris to unphysiologic stretch forces, causing TCS, especially when considering the hypermobile spine in hEDS. This notion is supported by the observed clinical improvement following FT resection in hEDS-TCS cases without a low-lying conus.

Vulvodynia in Patient with Labial Adhesions as Presentation of Tethered Cord Syndrome: A Case Report

Background: Occurring in 0.05-0.25/1000 births, tethered cord syndrome (TCS) is caused by fixation of the spinal cord to surrounding tissue by fibrous filum terminale, causing stretching and ischemia of the spinal cord. While common manifestations of TCS include bowel and bladder dysfunction, gait abnormalities, and neurological symptoms, this case report describes a unique presentation of TCS. The association of vulvodynia in a patient with labial adhesions as a presentation of TCS has not previously been documented.

Differences in postoperative complications and prognosis of sacrococcygeal teratoma and presacral tumors in Currarino syndrome

BackgroundWhile sacrococcygeal teratoma (SCT) is a tumor originating from the tip of the sacrum, presacral tumors are accompanied by Currarino syndrome (CS) and classified as the Altman’s type IV sacrococcygeal tumors. They are quite different in their pathologies despite the similar location. To the best of our knowledge, there are no published reports comparing their prognosis; therefore, we analyzed their postoperative results and long-term prognosis. Twenty patients with SCT, including CS, who were being followed up at the outpatient clinic of the Department of Pediatric Surgery, Miyagi Children's Hospital between 2004 and 2020, were enrolled in the study. Patients were divided into two groups: those who developed SCT without anorectal malformation and sacral dysplasia, and those who developed presacral tumors with anorectal malformation or sacral dysplasia as CS. Patient records were retrospectively reviewed for clinical details, postoperative complications, and long-term prognosis.ResultsTethered cord syndrome occurred significantly more frequently in the CS group (p = 0.0108). However, no significant differences were observed for malformations other than tethered cord syndrome. Early complications in the CS group were significantly higher than those in the SCT group (p = 0.023); the most common complication was dysuria. Regarding long-term prognosis, 70% of patients in the CS group complained of defecation disorders, which was significantly higher than that in the SCT group (p = 0.0198). Voiding dysfunction was also more common in the CS group.ConclusionsThere were significant differences between SCT and CS regarding the rate of development of tethered cord syndrome, short-term postoperative complications, and long-term prognosis. Thus, they are different diseases with the only commonality being the presence of a sacrococcygeal tumor. Furthermore, this study indicated that the background and prognosis of the two conditions were also quite different.

378 Sacral Dimpling and GI/GU Symptoms in KBG Patients May Indicate Comorbid Tethered Cord Syndrome (TCS)

INTRODUCTION: KBG is an autosomal dominant disorder characterized by costovertebral bony anomalies, scoliosis, and intellectual disability, and neurological disability. Tethered Cord Syndrome (TCS) is tissue tethering of the spinal cord due to a persistent embryological filum terminale causing subsequent bladder and bowel incontinence, scoliosis, and neurological signs and symptoms in the lower extremities. Tethered cord syndrome in genetic constellations, given the congenital nature, warrants further epidemiological studies. METHODS: Beyond the Diagnosis (https://www.beyondthediagnosis.org/), a local nonprofit organization in Rhode Island distributed an optional survey to members of their Facebook page in August 2020. Patients themselves or a family member chose to complete the optional survey about current symptoms and provided their age, sex, and consent to the responses being used in further research. Responses were anonymized and analyzed in Excel. Symptom prevalences across the responses and correlations between specific symptoms were calculated to explore whether a subset of symptoms among the patient sample was comorbid. RESULTS: 83 KBG patients answered the survey (dTCS, n = 10, sTCS, n = 73, average age = 9.71). The most prevalent symptoms were sacral dimple (60%), severe constipation (60%), and poor coordination (50%) among dTCS patients, and sacral dimple (65.75%), gait changes/leg weakness (58.90%), and severe constipation (43.84%) among sTCS patients. Objective signs of TCS were combined into GI/GU, neurocutaneous, and orthopedic sign clusters. Pearson matrix analysis showed a correlation (R = 0.339) between GI/GU and orthopedic signs, especially between bladder/bowel changes and orthopedic signs (R = 0.468). CONCLUSION: Surveyed sTCS patients had a high prevalence of TCS symptoms such as sacral dimples and GI/GU issues. Upon symptom clustering, there was a notable correlation between bladder/bowel changes and orthopedic signs.

A systematic review and meta-analysis of minimally invasive surgery in children with occult tethered cord syndrome.

BackgroundAt present, the surgical treatment of occult tethered cord syndrome (OTCS) in children is mostly two types of minimally invasive surgery: filum terminalis laxity or filum terminalectomy. The clinical efficacy and safety of minimally invasive treatment and conservative treatment are still unclear. Therefore, this study will use the advantages of systematic review and meta-analysis to evaluate the objectivity, and explore the effect of minimally invasive surgery on children with occult tethered cord syndrome.MethodsA computer search was used to search PubMed, Embase, CNKI, Wanfang Database and other literature search websites about the randomized controlled trials (RCTs) of minimally invasive surgery in children with occult tethered cord syndrome and spinal lipoma. Professional journals were manually searched to avoid omissions. The search keywords were: occult myelolipoma, occult tethered cord syndrome, surgical treatment of tethered cord syndrome, occult tethered cord syndrome.ResultsA total of 6 relevant literatures that could be used for meta-analysis were selected. A total of 425 subjects were included in the article, of which 132 were treated conservatively and 293 were treated surgically. The heterogeneity detection test statistics of the included studies were Chi2 (Chi-squared test) =8.18, df (degree of freedom) =5, I2=39%<50%, Z=2.53, and the homogeneity of the included studies was good. The number of unimproved cases under conservative treatment was 40, accounting for 30.30%; the number of unimproved cases under surgical treatment was 33, accounting for 11.26%, and the total unimproved rate of the two groups accounted for 17.17%. The unimproved rate of the experimental group was significantly lower than that of the control group, and the difference was statistically significant (P=0.01). The results of bias analysis showed that there was no significant bias in the literature included in this study.DiscussionMeta-analysis results confirmed that minimally invasive surgery has a significant effect on the treatment of occult children with tethered cord syndrome. However, due to the small sample size of the included literature, further evaluation of the treatment risk is required.

Retethering risk in pediatric spinal lipoma of the conus medullaris.

Lipoma of the conus medullaris (LCM) causes neurological symptoms known as tethered cord syndrome (TCS). The symptoms can be seen at diagnosis and during long-term follow-up. In this report, pediatric patients with LCMs who underwent untethering surgery, under the policy of performing surgery if diagnosed regardless of symptoms, were retrospectively reviewed to evaluate long-term surgical outcomes. Possible risk factors for retethered cord syndrome (ReTCS) were evaluated in the long-term follow-up period. A total of 51 consecutive pediatric patients with LCMs who underwent a first untethering surgery and were followed for > 100 months were retrospectively analyzed. The surgery was performed with the partial removal technique. Pre- and postoperative clinical and radiological data were reviewed to analyze the outcomes of surgery and identify potential risk factors for ReTCS. During follow-up, 12 patients experienced neurological deterioration due to ReTCS. The overall 10-year and 15-year progression-free survival rates were 82.3% and 75.1%, respectively. On univariate analysis, a lipoma type of lipomyelomeningocele (OR 11, 95% CI 2.50-48.4; p = 0.0014), patient age at the time of surgery (OR 0.41, 95% CI 0.14-1.18; p = 0.0070), and the mean patient growth rate after surgery (OR 2.00, 95% CI 1.12-3.41; p = 0.0040) were significant factors associated with ReTCS. Cox proportional hazard models showed that a lipoma type of lipomyelomeningocele (HR 5.16, 95% CI 1.54-20.1; p = 0.010) and the mean growth rate after surgery (HR 1.88, 95% CI 1.00-3.50; p = 0.040) were significantly associated with the occurrence of ReTCS. More complex lesions and a high patient growth rate after surgery seemed to indicate increased risk of ReTCS. Larger prospective studies and registries are needed to define the risks of ReTCS more adequately.

377 Complications of Pediatric Tethered Cord Release: Seattle Children’s Hospital Experience

INTRODUCTION: We describe six years of surgical experience at our pediatric neurosurgery center, with a wide variety of operative complexity and etiologies related to tethered cord syndrome. While complications are well-described, the risk of complications associated with complexity of the procedure needs further investigation. Based on our findings, we propose guidelines to minimize complications and give attention to certain high-risk groups of patients. METHODS: Medical records of children who underwent surgery for tethered cord release (CPT 63200) from July 2014 to December 2020 were retrospectively reviewed after approval by the Institutional Review Board at Seattle Children's Hospital. Data collected included demographics, surgical technique, follow-up, and complications. We defined surgeries as complex if they involved usage of any of the following: plastic surgeon assistance, drain placement, duraplasty, or operative laser. Univariate analysis and multivariate logistic regression were used to determine covariates that were protective or risk factors for development of complications. RESULTS: In 242 contiguous tethered cord operations (51.8% male, mean age 74.8 months), the overall complication rate of any type was 10.7% (3.45% simple, 17.46% complex). Median time until complication was 11 days. Complications were associated with usage of the operative laser, increasing hospital length of stay, and increasing operative time. Plastic surgery assistance (OR 0.357, 95% CI 0.197-0.647, p=0.0007) and placement of a drain (OR 0.314, 95% CI 0.134-0.739, p=0.008) for complex cases were protective against development of complications. CONCLUSION: Our complication rate is comparable to those of others (1-4). However, multivariate logistic regression analysis suggests that plastic surgery assistance and drain placement can be protective factors, and should be considered in complex tethered cord operations.

Preoperative Videourodynamic Study Is Helpful in Predicting Long-term Postoperative Voiding Function in Asymptomatic Patients With Closed Spinal Dysraphism.

PurposeControversy exists regarding the role preoperative urodynamic study for asymptomatic closed spinal dysraphism as it has failed to reveal the benefit in surgical decision and expectation of urological outcomes. We explore the relationship between preoperative videourodynamic study and postoperative urological outcomes after toilet training completed, focusing on their capability of spontaneous voiding.MethodsWe retrospectively reviewed the data of 181 patients who underwent preventive spinal cord untethering and followed at least till the completion of toilet training. Before untethering, patients underwent preoperative videourodynamic study. Postoperative voiding function was evaluated in 3 phases: (1) till postoperative 6 months, (2) till the completion of toilet training, and (3) 2 years after toilet training. Changing distribution of emptying pattern at each period was described. Also, relevance to preoperative urodynamic parameters on spontaneous voiding and urinary continence after toilet training was assessed.ResultsSpinal lipoma and low lying conus were found in 145 (80%) and 128 patients (70.7%), respectively. Spontaneous voiding was found in 125 (69.1%), 164 (90.6%), and 162 patients (89.5%) at postoperative 6 months, till the toilet training, and 2 years after toilet training, respectively. Videourodynamics helped to clarify the presence of vesicourethral synergy. This was correlated with spontaneous voiding at postoperative 6 months and better urinary continence after 2 years of toilet training.ConclusionsEventual spontaneous voiding was achieved till toilet training in 90% patients following preventive untethering. Those showing preoperative vesicourethral synergy was associated with faster achievement of spontaneous voiding and better urinary continence when they enter elementary school.

Sagittal spinopelvic alignment in tethered cord syndrome and split cord malformation

Purpose Sagittal imbalance is common in degenerative and congenital spinal diseases. Some studies have examined spinal deformities in the spina bifida. However, sagittal spinopelvic parameters in tethered cord syndrome (TCS) and split cord malformation (SCM) have been poorly evaluated in the literature. In this study, we investigated sagittal spinopelvic differences in TCS due to fatty filum terminale and SCM patients. Material and Methods A total of 78 patients with spina bifida occulta (30 SCM and 48 TCS due to fatty filum terminale) were included in the study. Radiological images of these patients were retrospectively evaluated. We evaluated the pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), T1 pelvic angle, lumbar lordosis (LL), thoracic kyphosis, thoracolumbar alignment, and change in those parameters with age. Results Correlation coefficients between age and LL, T1 pelvic angle, and the SVA in patients with TCS due to fatty filum terminale were statistically significant. In addition, correlation coefficients between age and LL and the SVA in patients with SCM were statistically significant. Notably, LL was increased at a statistically significant level with age in patients with TCS and SCM. Conclusion Improved knowledge of spinal balance parameters in patients with TCS and SCM may be helpful in understanding the clinical course of these pathologies, and provide information regarding the success of surgery at the follow-up period.

Flexible thecoscopy for extensive spinal arachnoiditis.

Chronic adhesive spinal arachnoiditis (SA) is a complex disease process that results in spinal cord tethering, CSF flow blockage, intradural adhesions, spinal cord edema, and sometimes syringomyelia. When it is focal or restricted to fewer than 3 spinal segments, the disease responds well to open surgical approaches. More extensive arachnoiditis extending beyond 4 spinal segments has a much worse prognosis because of less adequate removal of adhesions and a higher propensity for postoperative scarring and retethering. Flexible neuroendoscopy can extend the longitudinal range of the surgical field with a minimalist approach. The authors present a cohort of patients with severe cervical and thoracic arachnoiditis and myelopathy who underwent flexible endoscopy to address arachnoiditis at spinal segments not exposed by open surgical intervention. These observations will inform subsequent efforts to improve the treatment of extensive arachnoiditis. Over a period of 3 years (2017-2020), 10 patients with progressive myelopathy were evaluated and treated for extensive SA. Seven patients had syringomyelia, 1 had spinal cord edema, and 2 had spinal cord distortion. Surgical intervention included 2- to 5-level thoracic laminectomy, microscopic lysis of adhesions, and then lysis of adhesions at adjacent spinal levels performed using a rigid or flexible endoscope. The mean follow-up was 5 months (range 2-15 months). Neurological function was examined using standard measures. MRI was used to assess syrinx resolution. The mean length of syringes was 19.2 ± 10 cm, with a mean maximum diameter of 7.0 ± 2.9 mm. Patients underwent laminectomies averaging 3.7 ± 0.9 (range 2-5) levels in length followed by endoscopy, which expanded exposure by an average of another 2.4 extra segments (6.1 ± 4.0 levels total). Endoscopic dissection of extensive arachnoiditis in the dorsal subarachnoid space proceeded through a complex network of opaque arachnoidal bands and membranes bridging from the dorsal dura mater to the spinal cord. In less severely problematic areas, the arachnoid membrane was transparent and attached to the spinal cord through multifocal arachnoid adhesions bridging the subarachnoid space. The endoscope did not compress or injure the spinal cord. Intrathecal endoscopy allowed visual assessment and safe removal of intradural adhesions beyond the laminectomy margins. Further development of this technique should improve its effectiveness in opening the subarachnoid space and untethering the spinal cord in cases of extensive chronic adhesive SA.

Detethering of MRI-Demonstrated Tethered Cord Syndrome

Introduction: Recognition of tethered cord syndrome (TCS) in children is important because as the child grows, the spinal cord is stretched, leading to ischemia and subsequent neurological deficits, including bowel or bladder dysfunction, back and leg pain, or lower extremity weakness. Imaging findings raising concerns for tethering include presence of a fatty and/or thickened filum or a conus medullaris located caudal to L2. Objectives: The objective of this study was to describe the symptomatic presentation of TCS in our institution, detect demographic and diagnostic predictors of signs and symptoms, assess changes in symptoms over time, and examine whether demographic and diagnostic variables affect changes in symptoms over time. Methods: Using a retrospective chart review from patients who underwent detethering at our institution between April 1, 2015 and March 31, 2019, we report on the signs and symptoms of patients undergoing detethering surgery at presentation and examine possible demographic and diagnostic predictors of those symptoms and changes in symptoms over time. Logistic regression analyses were used to determine whether symptoms at presentation were related to demographic and diagnostic predictors and to assess a change in symptoms over time. Results: A total of 273 patients underwent detethering and were analyzed. Of these, 144 (53%) were <5 years of age, 151 (55%) were male, 233 (85%) had a fatty filum, 179 (66%) had a thickened filum, and 106 (39%) had a low-lying conus. Patients <5 years of age were less likely to have urological, gastrointestinal, and neurological or orthopedic symptoms; patients with thickened fila (i.e., greater than 2 mm in diameter regardless of fat-infiltration) were less likely to have urological symptoms; and patients with low-lying coni were less likely to have gastrointestinal symptoms. Patients exhibiting symptoms at presentation had reduced rates of symptoms at the follow-up, but a reduction in rates of symptoms over time was unrelated to demographic or diagnostic variables. Surprisingly, 123 (45%) patients presented with intractable constipation. Conclusion: In the population studied, several presenting symptoms, particularly constipation, were commonly reported. Children <5 years old were less likely to manifest clinically evident neurological/orthopedic, urological, and gastrointestinal symptoms than the older cohorts. Patients were less likely to report symptoms at both their first and second postoperative visit compared to presentation.

Long-term outcome following surgical treatment of posttraumatic tethered cord syndrome: a retrospective population-based cohort study

Study designRetrospective population-based cohort study.ObjectiveTo investigate the long-term outcome following surgery for posttraumatic spinal cord tethering (PSCT).SettingPublicly funded tertiary care center.MethodsPatients surgically treated for PSCT between 2005–2020 were identified and included. No patients were excluded or lost to follow-up. Medical records and imaging data were retrospectively reviewed.ResultsSeventeen patients were included. Median age was 52 (23–69) years and 7 (41%) were female. PSCT was diagnosed at a median of 5.0 (0.6–27) years after the initial trauma. Motor deficit was the most common neurological manifestation (71%), followed by sensory deficit (53%), spasticity (53%), pain (41%) and gait disturbance (24%). Median follow-up time was 5.1 (0.7–13) years. Fifteen patients (88%) showed satisfactory results following untethering, defined as improvement or halted progression of one or more of the presenting symptoms. Treatment goals were met for motor symptoms in 92%, sensory loss in 100%, spasticity in 100%, gait disturbance in 100% and pain in 86%. Statistically, a significant improvement in motor deficit (p = 0.031) and syrinx decrease (p = 0.004) was also seen. A postoperative complication occurred in four patients: three cases of cerebrospinal fluid leakage and one postoperative hematoma. Two patients showed a negative surgical outcome: 1 with increased neck pain and 1 with left arm weakness following the postoperative hematoma.ConclusionSurgical treatment of PSCT results in improved neurological function or halted neurological deterioration in the vast majority of patients.

Mullerian Choristoma as a Cause of Tethered Cord Syndrome: A Case Report in a 13-Year-Old Worsening after the Onset of Menarche

Mullerian Choristoma as a Cause of Tethered Cord Syndrome: A Case Report in a 13-Year-Old Worsening after the Onset of Menarche

Clinical Significance of Terminal Syringomyelia and Accompanying Congenital Anomalies of Neurosurgical Interest in Adult and Pediatric Patients with Tethered Cord Syndrome

AbstractMagnetic resonance imaging (MRI) can be used to examine tethered cord syndrome (TCS) and terminal syringomyelia (TS). Additionally, there is increasing evidence of an association between congenital anomalies and TCS. We aimed to identify the clinical and radiological characteristics of syringomyelia and other anomalies in pediatric and adult patients with TCS. This study included 54 TCS patients (mean age, 17.37 ± 15.83 years; 31 females) admitted to our department between 2010 and 2019. The patients were divided into two age groups: pediatric (&lt;18 years; 63%) and adult (&gt;18 years). Clinical findings, direct vertebrae radiographs, lower extremity radiographs, and spinal/cranial MRI findings were used to evaluate all patients. Computed tomography (CT) was performed to reveal the structure of the septum in patients with Diastematomyelia. Cranial ultrasonography or CT was performed if the fontanel was open or closed, respectively, in pediatric hydrocephalus cases. Pelvic ultrasonography and urodynamic tests were performed to evaluate other comorbid anomalies and urinary system pathologies. A thick filum terminale (73.3%) and diastematomyelia (44.4%) were found to cause spinal tension. The most common accompanying pathology was syringomyelia (78%). The common symptoms were urinary incontinence and bowel problems (71%), scoliosis (68%), and progressive lower extremity weakness (64.4%). It is difficult to distinguish the exact cause of symptoms in patients with TCS and TS. Due to the greater occurrence of other congenital spinal anomalies accompanying TCS, both preoperative symptoms and clinical findings are more severe in the pediatric group than in the adult group, and postoperative results may be more negative.

Changes in the Lumbosacral Angle after Spinal Cord Untethering in 23 Children with Tethered Cord Syndrome.

To analyze changes in the lumbosacral angle in children with tethered cord syndrome before and after spinal cord untethering surgery, and to determine the clinical value of such changes at the last follow-up. We retrospectively analyzed 23 children over 5 years old who were treated with spinal cord untethering in our hospital from January 2010 to January 2021 and who had complete medical data. X-rays were used to examine the child's spine preoperatively, postoperatively, and at follow-up with frontal and lateral radiographs, and lumbosacral angle data were measured and analyzed. A total of 23 children aged 5-14 years had their lumbosacral angles measured and analyzed with a postoperative followup of 12-48 months. The mean preoperative lumbosacral angle was 70.30 ± 9.04°, the mean postoperative lumbosacral angle was 63.34 ± 5.60°, and the mean lumbosacral angle at the last follow-up was 61.61 ± 9.14°. There was a statistically significant reduction in the lumbosacral angle in the children postoperatively and at the last follow-up compared to the preoperative period (p=0.002; p=0.001). Spinal cord untethering can improve the inclination of the lumbosacral angle in children older than 5 years with tethered cord syndrome.

Clinical analysis of tethered cord syndrome and gene expression profiling of wound healing surgery.

The method to prevent progression of symptoms in tethered cord syndrome (TCS) is neurosurgery. However, postoperative wound healing is a lengthy process and is hindered by the release of cerebrospinal fluid (CSF) through the wound. To the best of the authors' knowledge, there is no study evaluating the changes in the expression of factors involved in the wound healing process after neurosurgery for TCS. To clinically analyse 2 cases of TCS and evaluate the change in expression of selected genes during the postoperative wound healing process. Determination of TCS in two adult patients (woman, aged 26 years; man, aged 53 years) was based on magnetic resonance imaging (MRI). After confirming the initial diagnosis, a neurosurgical procedure was performed to remove the intrathecal spreading adipoma and transect the medullary terminal thread in patients. In the postoperative period, impaired wound healing was noted as a result of CSF secretion through the surgical wound. Molecularly, there was an increase in expression of all genes assessed in skin biopsy specimens compared to skin samples. Impaired postoperative wound healing after neurosurgery for TCS is expected due to CSF leakage through the surgical wound. The greatest changes were noted for metalloproteinases (MMPs) and four isoforms (A-D) of vascular endothelial growth factor A-D (VEGF-A-D; p < 0.05). Changes in the expression of our selected genes can be used to monitor and predict the process of wound healing and scar formation, which occurred in our cases at 19 and 20 days after surgery.

Comparison of conus medullaris levels and spinopelvic parameters between patients with adolescent idiopathic scoliosis, tethered cord syndrome, and healthy adolescents.

Comparison of conus medullaris levels and spinopelvic parameters between patients with adolescent idiopathic scoliosis, tethered cord syndrome, and healthy adolescents.