Prognosis of surgical treatment of the tethered cord syndrome in children

Object The goal of this study was to compare long-term results of surgery with the outcomes of conservative treatment in patients with asymptomatic lipomas of the conus medullaris. Methods The parents of 56 consecutive children with a diagnosis of asymptomatic lipoma of the conus medullaris underwent detailed neurosurgical consultation. The pros and cons of both prophylactic surgery and conservative treatment were carefully presented. Both options were offered, and the parents were free to choose the preferred management. A total of 32 children underwent surgical treatment, and 24 were conservatively treated. Afterward, all patients entered the same protocol of serial neurological and urological follow-up at the Centro Spina Bifida. The mean follow-up periods were 9.7 years in the surgical treatment group and 10.4 years in the conservative treatment group. Results Permanent surgical morbidity was 3.1% (1 patient). During follow-up, tethered cord syndrome occurred in 9.7% of the surgically treated patients (3 of 32 patients) and in 29.1% of the conservatively managed children (7 of 24 patients). This difference did not result in statistical significance, but a clear trend in favor of surgery emerged. Young age at surgery and a cord/sac ratio < 50% appeared to be determining factors in the prevention of subsequent tethered cord syndrome. Conclusions The small size of this series does not provide enough statistical evidence that surgical treatment can really improve the natural history of asymptomatic lipomas of the conus medullaris. Nevertheless, surgery appears at least advisable since it reduces by 75% the odds of TCS (p = 0.067), which is quite close to statistical significance.

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In Reply to the Letter to the Editor Regarding “Surgical Treatment of Tethered Cord Syndrome in Adults: A Systematic Review and Meta-Analysis”

World Neurosurgery ◽

10.1016/j.wneu.2020.04.023 ◽

2020 ◽

Vol 139 ◽

pp. 648

Author(s):

Camille K. Milton ◽

Kyle P. O’Connor ◽

Michael D. Martin

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Meta Analysis ◽

Tethered Cord ◽

Tethered Cord Syndrome ◽

Letter To The Editor

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An Unusual Presentation of Adult Tethered Cord Syndrome Associated with Severe Chest and Upper Back Pain

Case Reports in Orthopedics ◽

10.1155/2015/926185 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Shotaro Kanda ◽

Toru Akiyama ◽

Hirotaka Chikuda ◽

Takehiko Yamaguchi ◽

Kazuo Saita

Keyword(s):

Back Pain ◽

Surgical Treatment ◽

Lower Extremity ◽

Urinary Retention ◽

Tethered Cord ◽

Sudden Onset ◽

Tethered Cord Syndrome ◽

Lumbosacral Spine ◽

Resonance Imaging ◽

Lower Extremity Muscle

Adult tethered cord syndrome (ATCS) is a rare entity that usually presents with multiple neurological symptoms, including lower extremity pain, backache, lower extremity muscle weakness, and bowel/bladder disturbances. Prompt surgical treatment is often necessary to avoid permanent sequelae. We report a 63-year-old man with sudden-onset severe right chest and upper back pain, followed by urinary retention. His initial workup included computed tomography of the abdomen and pelvis, which showed a presacral mass. His symptom-driven neurological workup focused on the cervical and thoracic spine, the results of which were normal. Pelvic radiographs and magnetic resonance imaging of the lumbosacral spine showed spina bifida occulta, meningocele, and presacral masses consistent with a teratomatous tumor. His symptoms, except for urinary retention, improved dramatically with surgical treatment. The excised specimen contained a teratomatous lesion plus an organized hematoma. Hematoma formation was suspected as the trigger of his sudden-onset right chest and upper back pain.

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