scholarly journals Tethered spinal cord following repair of myelomeningocele

2004 ◽  
Vol 16 (2) ◽  
pp. 1-4 ◽  
Author(s):  
Roger J. Hudgins ◽  
C. Lynn Gilreath
Keyword(s):  
Spinal Cord ◽  
Clinical Presentation ◽  
Tethered Cord ◽  
Tethered Spinal Cord ◽  
Terminal Portion ◽  
Clinical Criteria ◽  
Orthopedic Surgeons ◽  
Clinical Presentations ◽  
Multidisciplinary Clinic ◽  
Surgical Release

Object The goal of this paper is to elucidate the clinical presentation of tethered cord syndrome (TCS) following repair of a myelomeningocele. Methods 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. Conclusions 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.

Spine-shortening vertebral osteotomy in a patient with tethered cord syndrome and a vertebral fracture

2008 ◽  
Vol 9 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Haruo Kanno ◽  
Toshimi Aizawa ◽  
Hiroshi Ozawa ◽  
Takeshi Hoshikawa ◽  
Eiji Itoi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Fracture ◽  
Rare Case ◽  
Tethered Cord ◽  
Conus Medullaris ◽  
Tethered Cord Syndrome ◽  
Bone Union ◽  
Tethered Spinal Cord ◽  
Fracture Fragment ◽  
Loss Of Correction

The authors report a rare case of tethered cord syndrome with low-placed conus medullaris complicated by a vertebral fracture that was successfully treated by a spine-shortening vertebral osteotomy. The patient was a 57-year-old woman whose neurological condition worsened after a T-12 vertebral fracture because a fracture fragment and the associated local kyphotic deformity directly compressed the tethered spinal cord. An osteotomy of the T-12 vertebra was performed in order to correct the kyphosis, remove the fracture fragment, and reduce the tension on the spinal cord. Postoperative radiographs showed the spine to be shortened by 22 mm, and the kyphosis between T-11 and L-1 improved from 23° to 0°. Two years after the surgery, the patient's neurological symptoms were resolved. The bone union was complete with no loss of correction.

Posterior vertebral column subtraction osteotomy: a novel surgical approach for the treatment of multiple recurrences of tethered cord syndrome

2009 ◽  
Vol 10 (4) ◽  
pp. 278-286 ◽  
Author(s):  
Patrick C. Hsieh ◽  
Stephen L. Ondra ◽  
Andrew W. Grande ◽  
Brian A. O'Shaughnessy ◽  
Karin Bierbrauer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Column ◽  
Spinal Column ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
The Novel ◽  
Tethered Spinal Cord ◽  
Vertebral Column Resection ◽  
Csf Leakage ◽  
Multiple Recurrences

Recurrent tethered cord syndrome (TCS) has been reported to develop in 5–50% of patients following initial spinal cord detethering operations. Surgery for multiple recurrences of TCS can be difficult and is associated with significant complications. Using a cadaveric tethered spinal cord model, Grande and colleagues demonstrated that shortening of the vertebral column by performing a 15–25-mm thoracolumbar osteotomy significantly reduced spinal cord, lumbosacral nerve root, and terminal filum tension. Based on this cadaveric study, spinal column shortening by a thoracolumbar subtraction osteotomy may be a viable alternative treatment to traditional surgical detethering for multiple recurrences of TCS. In this article, the authors describe the use of posterior vertebral column subtraction osteotomy (PVCSO) for the treatment of 2 patients with multiple recurrences of TCS. Vertebral column resection osteotomy has been widely used in the surgical correction of fixed spinal deformity. The PVCSO is a novel surgical treatment for multiple recurrences of TCS. In such cases, PVCSO may allow surgeons to avoid neural injury by obviating the need for dissection through previously operated sites and may reduce complications related to CSF leakage. The novel use of PVCSO for recurrent TCS is discussed in this report, including surgical considerations and techniques in performing PVCSO.

scholarly journals Tethered cord syndrome with spina bifida aperta in cats: two case reports of different types

2017 ◽  
Vol 3 (1) ◽  
pp. 205511691770806 ◽  
Author(s):  
Masahiro Tamura ◽  
Takashi Oji ◽  
Satoshi Une ◽  
Makiko Mukaino ◽  
Tatsuro Bekki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Urinary Incontinence ◽  
Spina Bifida ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Tethered Spinal Cord ◽  
Dural Sac ◽  
Spina Bifida Aperta ◽  
Different Types ◽  
Progressive Paraparesis

Case summary Two castrated male cats, aged 8 months old (case 1) and 10 months old (case 2), showed a history of progressive paraparesis, an over-reaching pelvic limb gait, urinary incontinence and a palpable dermoid fistula. In case 1, the fistula was connected to the dural sac on the conus medullaris, and the tethered spinal cord was retracted caudally. In case 2, the tubular structure was connected to the dural sac on the thoracic spinal cord, and the tethered spinal cord was retracted dorsally. Tethered cord syndrome secondary to spina bifida aperta was suspected in both cats. Excision of the fistula and release of the tethered spinal cord was performed. A histopathological examination confirmed the diagnosis of a meningomyelocele in case 1 and a meningocele in case 2. Paraparesis improved postoperatively in both cats. However, urinary incontinence in case 1 remained partially unresolved. Relevance and novel information This is the first report to describe the imaging characteristics, surgical treatments and outcomes of two different types of tethered cord syndrome with spina bifida aperta in cats. Tethered cord syndrome with spina bifida aperta needs to be included in the differential diagnosis of slowly progressive paraparesis in younger cats with or without vesicorectal failure and a palpable dermoid fistula.

Surgical management of the tethered spinal cord—walking the fine line

2007 ◽  
Vol 23 (2) ◽  
pp. E4 ◽  
Author(s):  
James M. Drake
Keyword(s):  
Spinal Cord ◽  
Treatment Strategies ◽  
Treatment Decision ◽  
Outcome Data ◽  
General Category ◽  
Tethered Spinal Cord ◽  
High Quality ◽  
Fine Line ◽  
Case Examples ◽  
Clinical Presentations

✓The tethered spinal cord is a fascinating yet controversial condition seen frequently in neurosurgical practice. Treatment decision making is made difficult by the variety of lesions and clinical presentations comprised by this condition and the absence of high-quality clinical outcome data to provide guidance. Clinical presentations may be divided into four general categories or typical scenarios: 1) significant dysraphic abnormality, clear clinical deterioration; 2) significant dysraphic abnormality, clinically normal or stable deficit; 3) incidentally discovered abnormality, other problem; and 4) tethered spinal cord symptomatology, normal imaging. The author provides case examples to illustrate potential treatment approaches and suggests balancing the risks and benefits for each general category. Clearer diagnostic and treatment strategies for the tethered spinal cord will only result from high-quality clinical and basic research. Until the results of such research are available, surgeons should endeavor to maximize benefit and reduce risk for patients who may have a tethered spinal cord, walking the fine line between over- and undertreatment.

Urologische Befunde nach Tethered cord-Operation - Urological Findings in Patients with Neurosurgically Treated Tethered Spinal Cord -

2000 ◽  
Vol 31 (2) ◽  
pp. 100-103
Author(s):  
D Filipas ◽  
M Fisch ◽  
U Herzog ◽  
M Schwarz ◽  
R Hohenfellner ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
Tethered Spinal Cord

Pathophysiology of adult tethered cord syndrome: review of the literature

2010 ◽  
Vol 29 (1) ◽  
pp. E2 ◽  
Author(s):  
William R. Stetler ◽  
Paul Park ◽  
Stephen Sullivan
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Tethered Spinal Cord ◽  
Spinal Cord Blood Flow ◽  
Pubmed Database ◽  
Spinal Cord Tethering

Object Tethering of the spinal cord has been a recognized cause of neurological symptoms in pediatric patients and is increasingly being recognized as a cause of symptoms in adults as well. The pathophysiology surrounding spinal cord tethering has begun to be understood in the pediatric population but is still unclear in adult patients. Methods Using a PubMed database literature search, the authors reviewed the pathology and pathophysiology surrounding the tethered spinal cord, focusing particularly on the pathophysiology of adult tethered cord syndrome (TCS). Results Experimental data obtained in pediatric patients at surgery and in animal models indicate that spinal cord tethering causes a reduction in spinal cord blood flow and dysfunction of neuronal mitochondrial terminal oxidase. Retrospective analyses of patients undergoing surgery for adult TCS show that many adults developed symptoms following an event that could stretch the spinal cord, while others did not. Many patients also were found to have structural lesions in addition to a tethered spinal cord at diagnosis. Conclusions Both adult and pediatric TCSs are likely the result of a relative lack of blood flow to the spinal cord, causing dysfunction in mitochondrial oxidative phosphorylation. The likely reason the syndrome present later and differently in adults is that a secondary threshold of tension or a cumulative effect of repetitive, transient tension is placed on the cord before symptoms are recognized.

Congenital tethered spinal cord syndrome in adults

1998 ◽  
Vol 88 (6) ◽  
pp. 958-961 ◽  
Author(s):  
Bermans J. Iskandar ◽  
Benjamin B. Fulmer ◽  
Mark N. Hadley ◽  
W. Jerry Oakes
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Early Surgery ◽  
Split Cord Malformation ◽  
Tethered Spinal Cord ◽  
Content Type ◽  
Fine Print

Object. The management of tethered spinal cord syndrome with onset of symptomatology occurring in adulthood remains controversial, although the necessity of early surgery in the pediatric tethered cord syndrome population is well established. To ascertain the results of surgery in adult patients with this anomaly, the authors undertook a retrospective review of 34 cases. Methods. The authors studied the hospital records of 34 consecutive patients who presented in adulthood with tethered cord syndrome and conducted follow-up phone interviews with 28 of them. The population consisted of 12 men and 22 women, ranging in age from 18 to 70 years (mean 34 years). The most common presenting feature was pain, followed by weakness and incontinence. All patients underwent surgery. The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies. Long-term surgical results and patient outcome ratings were encouraging. After a mean clinical follow-up period of 4 years, significant improvement occurred in 22 of 27 patients presenting with pain, 13 of 27 patients with motor or sensory dysfunction, and 11 of 18 patients with bowel and bladder disturbance. In addition, telephone interviews were obtained after a period of 8.6 years. Twenty-two (79%) of 28 patients called the operation a long-term success; 21 (75%) of 28 patients believed that they had significant postoperative improvement (and not just stabilization) in pain and/or neurological function. Surgical complications were generally minor. Nineteen (86%) of 22 employed patients returned to work after surgery. Two (33%) of six patients who were not employed before surgery worked full time postoperatively. Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work. Conclusions. Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. Because neurological deficits are generally irreversible, early surgery is recommended.

scholarly journals Pathophysiology of tethered cord syndrome and similar complex disorders

2007 ◽  
Vol 23 (2) ◽  
pp. 1-10 ◽  
Author(s):  
Shokei Yamada ◽  
Daniel J. Won ◽  
Gholam Pezeshkpour ◽  
Brian S. Yamada ◽  
Shoko M. Yamada ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Oxidative Metabolism ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Functional Disorder ◽  
Tethered Spinal Cord ◽  
Complex Disorders ◽  
Caudal Portion ◽  
Similar Complex

✓Tethered cord syndrome (TCS) is a stretch-induced functional disorder of the spinal cord due to the fact that its caudal portion is anchored by an inelastic structure. The functional lesion of TCS is generally situated in the lumbosacral cord, and many authors have shown that the syndrome is reversible via surgery to untether the cord. To clarify the expressions relevant to TCS, such as “cord tethering” and “tethered cord,” the authors have formulated three categories. These categories include cases that show the anatomical appearance of spinal cord stretching. Among them, Category 1 is isolated to represent the “true TCS.” The authors focus their discussion of the pathophysiology of TCS on Category 1 to explain the impaired oxidative metabolism and electrophysiological derangements within the tethered spinal cord, which is the primary intrinsic cause of the dysfunction. Furthermore, they extend the discussion to the extrinsic (outside the spinal cord) factors and other complex conditions that mimic TCS.

scholarly journals Response of Scoliosis in Children with Myelomeningocele to Surgical Release of Tethered Spinal Cord

2016 ◽  
Vol 22 (4) ◽  
pp. 247-252 ◽  
Author(s):  
Haluk Altiok ◽  
Anne Riordan ◽  
Adam Graf ◽  
Joe Krzak ◽  
Sahar Hassani
Keyword(s):  
Spinal Cord ◽  
Tethered Spinal Cord ◽  
Surgical Release

Adult Onset of Tethered Spinal Cord Syndrome Due to Fibrous Diastematomyelia: Case Report

Neurosurgery ◽  
1985 ◽  
Vol 16 (5) ◽  
pp. 681-685 ◽  
Author(s):  
Bahram Chehrazi ◽  
Scott Haldeman
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Tethered Spinal Cord ◽  
Rare Entity ◽  
Adult Onset ◽  
Diagnostic Difficulty ◽  
Surgical Release

Abstract Adult onset of the symptoms of tethered spinal cord is a rare entity that is occasionally associated with diastematomyelia. Only one case of fibrous diastematomyelia in an adult has been reported. The fibrous nature of this disease may present a diagnostic difficulty. A 32-year-old man with the adult onset of impairment of sacral functions with lumbar fibrous diastematomyelia is reported. Surgical release of the spinal cord was followed by improvement of the patient's function.

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