1 Shuaifuyuan, Dongcheng District, Beijing 100730, People's Republic of China (e-mail: [emailprotected]). Tight terminal filum is easy to manage and has excellent outcome, but the complexity of the other pathologies makes it difficult to achieve sufficient clinical results in those cases.7 A retrospective analysis of 82 adult patients (17 male cases, 82% and 24 female cases, 59%) with TCS treated by surgery was conducted between March, 2005 and December, 2015, with an average age of 31.6 years and average disease course of 6.7 years. Surgical complications were generally minor. Search for Similar Articles These back pains were treated conservatively with oral analgesic agents. Eleven patients underwent untethering surgery, and 3 patients underwent SSO surgery. The authors reviewed their institutional experience with the surgical management of adult TCS to assess the time course of symptomatic improvement, and to . 4 The preoperative pathology was lipomeningocele in all SSO group and lipoma or tight terminal filum in the untethering group. 5. At your childs first pediatric neurosurgical appointment, you can expect discussions with the care team about whether surgery is appropriate for your child and whether they need different imaging tests done. This causes extra stress on the nerves and can cause a range of symptoms known as tethered cord syndrome. 9 Patients with such complex pathologies have been found to have a 9 to 50% chance of worsening pain and sensorimotor deficits after untethering.7 Unlike pediatric patients, adults experience degenerative changes that further complicate treatment.5 2007 Mar;6(3):210-5. doi: 10.3171/spi.2007.6.3.210. WebWhen a portion of the spinal cord becomes attached to lesions within the spinal column, excess strain can cause signs and symptoms such as pain, motor deficits, sensory deficits, bladder dysfunction, and bowel dysfunction. 4 Of 40 cases without occupying lesions of TCS, the symptoms were improved in 14 cases and stabilized in 26 cases, there was no deteriorated case. Tethered cord, also called tethered spinal cord syndrome, occurs when the spinal cord has abnormal attachments inside the spinal canal, usually at the base of the spine. Short-term results were determined within 3 months of surgery, whereas long-term outcomes (clinical recurrences) were evaluated using Kaplan-Meier statistics. Tethered cord release surgery is a type of surgery to reduce or remove the tissue that is preventing the spinal cord from moving freely. Improvement in clinical features was compared in the untethering and SSO groups (Table 3). This site needs JavaScript to work properly. School-age children are typically out of school for 2 weeks. The mean duration of follow-up was 4.73.5 years (range, 2.0 to 15.5 years). All 6 patients had tethered spinal cords, and 1 patient in each group had diastematomyelia. Scheduled medications for pain relief during the early post-operative period at home include: There may be additional pain medications given as needed for breakthrough pain. Pang D, Wilberger J E Jr. Tethered cord syndrome in adults. Nineteen (86%) of 22 employed patients returned to work after surgery. By preoperative Hoffman grading, in the 20 cases with grade 1, 8 cases of patients indicated symptoms improvement to grade 0; in cases with grade 2, 6 cases of patients were improved and transferred to grade 1, and 2 cases of patients transferred into grade 0; in cases with grade 3, 4 cases of patients showed improved symptoms and changed into grade 2; in cases with grade 4, 2 cases were improved and changed into grade 3. A retrospective analysis of 82 adult patients (17 male cases, 82% and 24 female cases, 59%) with TCS treated by surgery was conducted between March, 2005 and December, 2015, with an average age of 31.6 years and average disease course of 6.7 years. Tethered cord syndrome in childhood: special emphasis on the surgical technique and review of the literature with our experience. Let us help you navigate your in-person or virtual visit to Mass General. Surg Neurol Int. In this study, we evaluated the feasibility of BCR monitoring during untethering surgery in infants and children to predict postoperative urinary and bowel dysfunction. 11 Miyakoshi et al reported complete clinical recovery without complications in 2009, which led to the hope that SSO would be the way to reduce perioperative complications and provide better neurologic outcomes.10 Although Kokubun et al also reported good clinical results after SSO in 2011,11 there have been no reports until now of a comparative study or review of these two procedures. Epub 2017 Feb 13. [2], In 1886, Von Reeklinghausen reported autopsy results of the patients with lumbosacral hypertrichosis accompanied with spina bifida, showing that the spinal cord was adhered to fat in the lumbosacral region, conus terminalis was indicated to be tensed. Shinjo T, Hayashi H, Takatani T, Boku E, Nakase H, Kawaguchi M. J Clin Monit Comput. Although it was difficult to compare clinical outcomes due to the small numbers of patients and heterogeneity, SSO might be preferable for improving the symptoms in adult TCS after considering these baseline differences. In adults, if the only abnormality is a thickened, shortened filum, then a limited lumbosacral laminectomy may suffice, with division of the filum once identified. Laurent D, Bardhi O, Gregory J, Yachnis A, Governale LS. doi: 10.1097/BRS.0b013e3181fc2edd. Since 1991, data obtained in 2515 patients with spinal cord pathologies were entered into the spinal cord database, and prospective follow-up was performed through outpatient visits and questionnaires. An umbilical hernia repair is a relatively routine surgery and takes about 20 to 30 minutes. Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. First, it was a retrospective review of a small number of patients, due to the fact that the number of adult patients with TCS is relatively low, so securing a large number of patients for the study (especially patients with SSO) was difficult even though the study was a multicenter one. Throughout her time in high school, she had frequent . Adults with Tethered Cord Syndrome Find Relief Through You may be trying to access this site from a secured browser on the server. government site. Published by Wolters Kluwer Health, Inc. Federal government websites often end in .gov or .mil. This study has two limitations in particular. This is not associated with spina bifida, but may occur in patients with Chiari malformation. The Authors. [12], The possibility of self-growth of lipoma is relatively low, and it is closely related to the increase or decrease of fats from other parts of the body. The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies. Disclosures Hiroaki Nakashima, none In the case of adult tethered cord not . In adults, dethetering of the spinal cord . Tethered cord release surgery has risks including permanent neurological changes such as of sensation and further lower extremity weakness, change in gait and at times reversible loss of the ability to ambulate. 6 Muscle weakness was present in 10 patients (71%), 8 (57%) had leg pain and sciatica, and 6 (43%) had back pain. Unauthorized use of these marks is strictly prohibited. Surgery Neurol Sci. Meanwhile, patients with shorter disease courses were suggested to accompany with obvious improvement of symptoms postoperatively when compared to those patients preoperatively; besides, the course of disease was within 1 year regarding those patients showing a completely recovery of the abovementioned symptoms. Gupta S K Khosla V K Sharma B S Mathuriya S N Pathak A Tewari M K. Akay K M, Erahin Y, Cakr Y. Tethered cord syndrome in adults. 1B). Depending on your childs age, symptoms of tethered cord syndrome vary. 12 The causes of tethering, preoperative duration of symptoms, and completeness of untethering could cause the outcomes to vary. All patients received general anesthesia and took their prone position, neural electrophysiological monitoring electrode were then placed, followed by the acquisition and collection of muscle electromyography signals from the anal sphincter, bilateral musculus vastus lateralis, gastrocnemius and mesothenar. He or she can have a pillow but do not raise the head of the bed. For cyst wall with many serious adhesions of cauda equina nerve, partial resection of the cyst wall can be performed under electrophysiological monitoring, which will also have a good operation effect. Patients needing surgery for adult TCS are relatively young, so this postoperative complication would be a serious disadvantage of SSO for them. 11 The mean age at onset of symptoms and diagnosis was 30 years and 37 years, respectively. Asian J Neurosurg. Yamada S, Won D J, Pezeshkpour G. et al. Shiro Imagama, none In the article, Surgical treatments on adult tethered cord syndrome: A retrospective study, which appeared in Volume 95, Issue 46 of Medicine, a sentence in the abstract, A retrospective analysis of 82 adult patients (17 male cases, 82% and 24 female cases, 59%) appeared incorrectly and should have appeared as A retrospective analysis of 82 adult patients (34 male cases, 41.5% and 48 female cases, 58.5%) In , the totals in the Complete release and Partial release columns appeared incorrectly and should have appeared as seen in the table below. Surgical experience of 120 patients with lumbosacral lipomas. 10 In adults, surgery to free (detether) the spinal cord can reduce the size and further development of cysts in the cord. neurologic recovery with regard to pain and Tethered Spinal Cord Syndrome | National Institute of At present, the classification of lipoma-oriented TCS is confused, Arai et al[15] had classified it into 5 different kinds, including the dorsal, caudal, combined, filar, and lipomyelomeningocele; while it was subdivided into the lower conical, lateral conical, and upper conical by Wang et al. Liu JJ, Guan Z, Gao Z, et al. Bristow RG, Laperriere NJ, Tator C, et al. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 2015-1002-02-09; grant recipient: XK). WebThe dysfunction of nervous system in Cases 1, 2, and 4 disappeared within 3 weeks. The preoperative duration of symptoms was significantly longer (2512.4 years) and the percentage of those with prior surgery was higher in the SSO group (66.7%). As this is just a retrospective study that does not involve any interventions, ethical approval was not necessary according to the rules of the hospital. Depending on the type of tethered cord your child has, they may be more at risk for re-tethering (when the spinal cord reattaches to tissue). Tethered Cord Syndrome (TCS) is a broad term that encompasses both congenital (primary) and acquired (secondary) pathologies that anchor, elongate and tension the spinal cord[1] The spinal cord fixation produces mechanical stretch, distortion, and ischemia with daily activities, growth, and development[2] This prevents the spinal cord from freely moving, which then increases . Through the follow-up of 56 cases of adult TCS patients, Httmann et al[9] found that the pain relief rate was 86%, which was the most obvious symptoms that alleviated, remission rate of the lower limb spasticity was 7l%, and the remission rate of bladder dysfunction and feeling movement dysfunction was 44% and 35%, respectively. Lumbosacral laminectomies were performed to obtain adequate exposure of the conus medullaris and cauda equina. Some surgeons require the patient to remain flat in bed for a couple of days to minimize the risk of spinal fluid (CSF) leakage from the wound. Tethered Spinal Cord | Boston Children's Hospital Yamada and Lonse[18] divided 70 cases of adult TCS patients into 2 groups, who underwent surgical treatment and followed by comparative analysis, patients with longer course of disease were found to show limited relief of motor sensory dysfunction and bladder dysfunction; pain in the lumbosacral portion and both lower extremities was relieved 3 months after surgical relaxation of the tethered cords; and in patients with shorter disease duration following surgical lysis, motor sensory dysfunction and bladder dysfunction were improved significantly, pain symptoms also alleviated rapidly. Spinal column shortening is an indirect detethering surgery which shortens and fuses the spine to relieve longitudinal pressure on the spinal cord. 19-42. . official website and that any information you provide is encrypted . Congenital tethered spinal cord syndrome in adults You may search for similar articles that contain these same keywords or you may As with any surgery, tethered cord surgery has risks and complications. It is pulled tightly at the end, reducing blood ow to spinal nerves and causing damage to the spinal cord from both the stretching and the decreased blood supply. You will have many questions about the disorder, and we are here to answer them. For patients combined with subcutaneous giant lipoma in the lumbosacral region, the subcutaneous tumor was removed, and the drainage tube was placed into the left empty cavity, followed by pressurized dressing and vacuum aspiration. The operation curative effects with curative rates for TCS with different symptoms, and signs are shown in Table 2 in detail. Data is temporarily unavailable. Horrion J, Houbart MA, Georgiopoulos A, et al. A retrospective analysis of 82 adult patients with TCS treated by surgery was conducted between March 2005 and December 2015 in Peking Union Medical College Hospital. 19. 9 9 A total of 72 cases applied positive straight incision, 10 cases of lumbosacral lipoma with longitudinal incision. In a baby with Spina bifida the spinal cord is still attached to the skin around it preventing it from rising properly. Recovery of lost muscle and bladder function depends upon the degree and length of preoperative implications. Fixing Tethered Cords in Children vs. Neurological outcome after surgical management of WebThe clinical recurrence rate in all conservatively treated patients was 21% after 10 years. WebConclusions: Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. OBJECTIVE Tethered cord syndrome (TCS) has been well described in pediatric patients. WebRecovery from the surgery is one to two weeks of very limited activity to ensure proper healing of the surgical site and to prevent leaking of any cerebrospinal fluid. 13 On the other hand, although massive intraoperative bleeding is a problem, the percentage of cases in which complications have developed has been low with SSO (Table 5). The patient with symptoms following resection of a lipomyelomeningocele: do increases in the lumbosacral angle indicate a tethered spinal cord? 16. The most common symptoms of tethered cord, such as back pain, abnormal gait and urinary accidents are frequently attributed to other causes during childhood. . Tethered cord syndrome (TCS) is a neurologic disorder caused by abnormal traction of the spinal cord resulting from several pathologic conditions: thickened filum terminale, meningocele, lipomyelomeningocele, and split cord malformation.1 2. and transmitted securely. Tethered cord syndrome in adults: experience of 56 patients. 12. 5 Given radiographic findings of tethered cord syndrome and clinical symptoms of pain, UTIs, urinary retention requiring catheterization, and constipation, it was recommended that the patient undergo untethering of the spinal cord via sectioning of the fatty filum terminale. For this procedure, the patient is placed under general anesthesia. 9 Two (33%) of six patients who were not employed before surgery worked full time postoperatively. Nakashima H, Imagama S, Matsui H, Yukawa Y, Sato K, Kanemura T, Kamiya M, Ito K, Matsuyama Y, Ishiguro N, Kato F. Global Spine J. MeSH TCS in adults is relatively rare and includes a wide spectrum of pathologies.1 Van Leeuwen et al established four subgroups based on their original tethering pathologies and reported the clinical outcomes after untethering surgery: (1) postrepair myelomeningocele; (2) terminal filum lipoma and tight terminal filum; (3) lipomyelomeningocele and conus lipoma; (4) split cord malformation.5 These etiologic backgrounds were found to affect the clinical outcome after untethering. WebAdult Tethered Cord Release - cns.org Open Access The Nexus online library is your free comprehensive resource for neurosurgical cases and approaches. Tethered cord syndrome is a rare neurological condition. Get the latest news on COVID-19, the vaccine and care at Mass General. All of the included 82 cases of patients received preoperative enhanced magnetic resonance imaging (MRI) examination, and there were several characteristics listed as follows: thickened filum terminale in a diameter of >2 mm; elongated, tapering, and low position of the coni medullaris, the coni medullaris located below the plane of vertebral body (L2) was considered to be low position of the coni medullaris; coni medullaris or the filum terminale attached closely to the posterior wall of the thecal sac, in a relatively straight shape; a large subarachnoid space was existed in the sacral canal; possible existence of occupying lesions adhered to the coni medullaris or the cauda equina, such as lipoma, dermoid cyst, and epidermoid cyst; potential existence of myelomeningocele or changes after prosthesis (Fig.