Tethered Cord Syndrome In Children Research Articles

Surgical treatment of lipoma type tethered cord syndrome in children

Objective To investigate the surgical treatment and its efficacy of lipoma type tethered cord syndrome(TCS)in children. Methods The clinical data of 245 children with lipoma type TCS admitted to the Department of Neurosurgery, Chinese PLA General Hospital from January 2008 to January 2015 were analyzed retrospectively. According to the imaging findings, the 245 children were divided into four types: dorsal type, caudal type, chaotic type, lipo-myelomeningocele type. All the children were treated with microsurgery. Spina bifida neurological scale(SBNS)was used to evaluate the efficacy of surgical treatment. The follow-up time ranged from 6 to 60 months. Results The total effective rate of 245 children with lipoma type TCS after procedure was 76.0%. Among all types of TCS, the effect of dorsal type was best, and then followed by caudal type, lipo-myelomeningocele type, and chaotic type. The effect of total resection(near total resection)group was better than the subtotal resection group. Conclusions Once the lipoma type TCS is diagnosed, early surgery can prevent or reduce the defecation dysfunction and both lower extremity dysfunction after the growth and development of children. Surgery should strive to total or subtotal resection of lipomas in order to complete release of the spinal cord and cauda equine. The main factors for influencing the operative effect and prognosis were the types of lipomas, timing of operation, preoperative symptoms, complete neurolysis or not, and having retethering or not. Key words: Tethered cord syndrome; Classification; Microsurgery; Prognosis

Histological structure of filum terminale in human fetuses

The structure of the filum terminale (FT) is important in the development of tethered cord syndrome (TCS) in children. Although many studies have been performed on the histological structure of the FT in adults, there has been no detailed investigation for those of fetuses. The aim of this study was to examine the histological structure of the FT in normal human fetuses and to compare the results with those of previous studies. The histological examination of the FT was performed in 15 normal human fetuses; 11 of them were female and 4 were male. The gestational age of the fetuses ranged between 14 weeks and 35 weeks, and they weighed between 180 g and 1750 g. The FT of each fetus was cut and examined for adipose tissue, fibrous tissue, peripheral nerve, ganglion, ependymal cells, gliosis, elastic fibers, and collagen types (Types I and III). Adipose tissue was observed in 2 specimens (13%), whereas fibrous tissue was found in 8 specimens. Peripheral nerve was detected in 11 (73%), ganglion in 6, ependymal cells in 5, and glial tissue in 7 FT samples. Type III collagen was present in 12 specimens (80%) with different concentrations, whereas Type I collagen and elastic fibers were not detected. The normal structure of the FT in fetuses is different from its structure in adults. The FT has no elasticity during intrauterine life because of the lack of elastic fibers. More detailed studies are needed to understand the histological basis of TCS in children.

Tethered cord syndrome in adults.

Patients with tethered cord syndrome (TCS) rarely have symptomatic onset in adulthood. Twenty-three adult patients with TCS were studied with respect to the clinical, radiological, and pathological features of this syndrome. Specific circumstances involving either additional tugging of the already tight conus, narrowing of the spinal canal, or direct trauma to the back or buttocks precipitated symptomatic onset in 60% of patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities as well as bladder and bowel dysfunction were also common findings; but, unlike TCS in children, progressive foot and spinal deformities were not seen. As in TCS with onset in childhood, the most common tethering lesions were thickened filum, intradural lipoma, and fibrous adhesions. The degree of cord traction, rather than the type or distribution of the tethering lesions, probably determines the age of symptom onset: less severe traction remains asymptomatic in childhood but results in neurological dysfunction in later life due to repeated tugging of the conus during natural head and neck flexion, or when abnormal tension is aggravated by trauma or spondylotic canal stenosis. Metrizamide myelography revealed the diagnosis of tethered conus in most cases, but the addition of computerized tomographic imaging provided valuable structural details concerning the tethering lesion. The surgical outcome was gratifying in relation to pain and motor weakness but disappointing in the resolution of bowel and bladder dysfunction. Early diagnosis and adequate release of the tethered conus are the keys to successful management.