12 Treatment of TCS in adults is challenging because these malformations are rare, and adults may present with degenerative changes.9 Moreover, many adults with TCS have undergone previous surgery for myelomeningocele repair or untethering in childhood, which further complicates treatment.7, Untethering surgery has been commonly performed in the management of TCS in adults and children.7 However, neurologic recovery with regard to pain and neurologic deficit shows great variation, with improvement rates ranging from 0 to 100%.1 Surgeries were performed under continuous electrophysiologic neuromonitoring with somatosensory-evoked potentials, combined with motor-evoked potentials, and electromyography with direct nerve root stimulation. 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. Each time she had a surgery to scrape away the scar tissue, there was more of it, and her doctors had to make larger incisions on her back. Surgery in adult patients with a tethered cord syndrome should be reserved for those with symptoms. They are the result of incorrect "dysjunction" of the neuroectoderm with incomplete separation of the epidermis (overlying skin) from the neural tube (spinal cord and central nervous system) and . The purpose of this study was to compare the clinical outcomes of the two procedures for TCS in adults. To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). modify the keyword list to augment your search. eCollection 2020. A total of 32 consecutive adult patients underwent untethering surgery for secondary tethered cord syndrome in our department from January 2008 until December 2018. An adult tethered cord syndrome has also been described. 2 13 Therefore, untethering surgery is not always a promising procedure.11. 2021 Feb 16;88(3):637-647. doi: 10.1093/neuros/nyaa491. 2001 Jan 15;10(1):e7. The summary of outcomes from previous reports (Table 4) shows that the improvement of symptoms after surgery was more frequently observed with SSO. 11 Tethered cord syndrome is a rare neurological condition. 4 He presented with symptoms of lower back pain and legs pain. Abstract. He underwent SSO 1.5 years after untethering surgery. Neurophysiologic intraoperative monitoring is when doctors place electrodes (wires with a sticker on one end) on your childs head, arms and legs. What is Adult Tethered Cord? Although untethering surgery has been a standard treatment in patients with adult tethered cord syndrome (TCS), spine-shortening osteotomy (SSO) has recently been performed as an alternative technique. Pediatric pathology all grown up - An interesting case of adult tethered spinal cord. At surgery, the spinal cord was freed from its attachments to the dura, and the symptoms resolved [13]. 6 Post-operative radiotherapy for recurrent dermoid cysts of the spine: a report of 3 cases. In adults, symptoms of tethered cord usually develop slowly. As for the postoperative complications, there were 4 cases (5%) of spinal fluid leakage, and the 2 patients were cured following vacuum aspiration and pressurized dressing; there were 6 cases (7%) showing delayed wound healing, mainly caused by spinal fluid leakage or fat liquefaction. Management of adult tethered cord syndrome: our experience and review of literature. With a recommendation for surgery this figure rose to 47% within 5 years. Disclaimer. SSO is a highly invasive type of surgery, but as the average age of adults with TCS ranges from 35 to 46 years,1 Bethesda, MD 20894, Web Policies Surgery to detach the spinal cord from the sheath. HOB, positioning, activity, bathing: The patient is kept flat on bed rest for 3 days to allow for dural healing and to put as little CSF pressure on the dura as possible during this time. ERAS is a set of steps to follow to help people recover better and faster after surgery. [2] As for normal embryo under 20 weeks, the termination of spinal cord was located at the level of L4 to L5, and at the level of L3 under 40 weeks, when the baby was born, it was located at the level of L1 to L2. HHS Vulnerability Disclosure, Help The patient was followed up for 2 years without local recurrence. Surgery to remove lipomas and free a tethered spinal cord. In adults, surgery to free the spinal cord can reduce the size and further development of cysts in the cord and may restore some function or alleviate other symptoms. Neurosurg Focus. Would you like email updates of new search results? Despite having symptoms from birth, I was only recently . Fixing Tethered Cords in Children vs. Of 10 cases with lipoma tethered spinal cord, corresponding symptoms were improved in 2 cases. Fatty Filum Terminale. The care team will place a urinary catheter to help urine flow out of your childs body during and after surgery. 5 Tethered cord syndrome in childhood: special emphasis on the surgical technique and review of the literature with our experience. 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. This keeps the spinal cord from moving freely, leading to stretching and tension that can cause nerve damage. August 2017. The authors have no conflicts of interest to disclose. Other clinical features at presentation included foot deformity in 9 patients (64%) and scoliosis in 4 patients (29%). CSF leakage and urinary infection each occurred in 1 patient in untethering surgery cases, and massive intraoperative bleeding (more than 3,000 mL) was observed in 1 patient in the SSO group. This causes extra stress on the nerves and can cause a range of symptoms known as tethered cord syndrome. The authors reviewed their institutional experience with the surgical management of adult TCS to assess the time course of symptomatic improvement, and to . The percentage of patients with prior surgery was higher in the SSO group than in the untethering group, although the difference was insignificant. and transmitted securely. There were 4 cases of patients with grade 0 by preoperative Hoffman grading, 20 cases with grade 1, 28 cases with grade 3, 18 cases with grade 4, 10 cases with grade 5, and remaining 2 cases with grade 6. We talked about bracing but it had to be delayed because a follow up MRI showed a tethered cord that needed surgery. A tethered cord release reduces or removes the . The severity of the condition and the associated signs and symptoms vary from person to person. Unauthorized use of these marks is strictly prohibited. 3332016010; grant recipient: XK) and Peking Union Medical College Graduate Student Innovation Fund (2015) (project no. 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. The variations of tethering lesions were tight terminal filum (present in 1 patient), lipoma (5 patients), and lipomyelomeningocele (8 patients). Keyword Highlighting This can cause the spinal cord to stretch out as the spine grows, leading to possible nerve damage, pain and other symptoms. In addition, telephone interviews were obtained after a period of 8.6 years. 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 Over time, the term ''tethered cord'' has been . If the nerves are stretched, they may not work properly, and this can cause problems for your child. This condition is 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. Surgical treatment on adult patients with TCS can improve the neurologic deficits which are associated with the course of disease, early treatment has much better curative effect. The end of the spinal cord normally hangs and moves freely inside the spinal column. As the child grows taller, the spinal cord is stretched. 10. Your child will also need a COVID-19 PCR test 48 hours (2 days) before surgery. 96(32):e7808, I am just your average. This abnormal attachment is associated with progressive stretching and increased tension of the spinal cord as a child ages, potentially resulting in a variety of . 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. Patients needing surgery for adult TCS are relatively young, so this postoperative complication would be a serious disadvantage of SSO for them. Medicine. 8 Patients who underwent surgery for TCS secondary to posttraumatic or postinflammatory conditions were not included in this study. 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. The position in which it comes to rest in an adult (L1 or L2) is caused by the growth of the individual. J Neurosurg Spine. 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. Her curves when checked were Top - 23 and bottom - 23. Careers. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We would like to thank our colleagues from the Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, and the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University. School-age children are typically out of school for 2 weeks. sharing sensitive information, make sure youre on a federal If no imaging has been done, your child may need a magnetic resonance imaging (MRI) test of their spine before the appointment. Bethesda, MD 20894, Web Policies Tethered cord syndrome (TCS) refers to a series of neurological dysfunction caused by the retraction of the conus medullaris related to a variety of reasons, which is manifested by both lower extremities orbicularis weakness, sensory abnormalities, defecation dysfunction, and so on.[1]. You will have many questions about the disorder, and we are here to answer them. Bookshelf Disclosures Hiroaki Nakashima, none All 6 patients had tethered spinal cords, and 1 patient in each group had diastematomyelia. WebThe clinical recurrence rate in all conservatively treated patients was 21% after 10 years. The https:// ensures that you are connecting to the 9 Moreover, successful untethering correlates with the complexity of the malformation and is extremely difficult to accomplish without causing intraoperative complications.9 Consequently, untethering surgery for adult patients with complex tethering pathologies remains challenging.9. National Library of Medicine WebTethering can happen before or after birth in children and adults with Spina Bfida, and most often occurs in the lower (lumbar) level of the spine. The tethering effect was caused either by a split cord malformation, a thick filum terminale, a conus medullaris lipoma with extradural extension, or various combinations of these mechanisms. One patient in the untethering surgery group underwent SSO because the symptoms worsened 1year after untethering. government site. The purpose of this study was thus to fill in this knowledge gap by comparing the surgical results of untethering surgery and SSO for treating TCS in adults. Funding/support: This study was supported by Peking Union Medical College Youth Research Funds (2016) (project no. 13 On the other hand, even when the neurologic deficits are not severe at the time of presentation,9 sensory deficits and urologic dysfunction are more likely to remain static.1 However, untethering carries risks of spinal cord injury and re-tethering. 2018 Mar;97(11):e0111. In the early stage of embryo, spinal cord and vertebral canal were roughly equal, but in the later development process, bony spinal growth were indicated to be faster, which was out of synchronization with the growth of spinal cord. Object: Although postsurgical neurological outcomes in patients with tethered cord syndrome (TCS) are well known, the rate and development of neurological improvement after first-time tethered cord release is incompletely understood. Get the latest news, explore events and connect with Mass General. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, People's Republic of China (e-mail: [emailprotected]). To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). 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). In children, the surgery to de-tether the spinal cord is more common and can be done at many institutions; the procedure is also lower risk in children than in adults. This calls for a wider recognition of the fact that tethered cord syndrome can present in adulthood also. 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. Abnormal tissue, growth, tightening, or thickening of tissue can make it hard to move the spinal cord. The site is secure. 8 Log in now and start reading! Tethered cord means the spinal cord cannot move inside the spinal column. Muscle weakness was present in 10 patients (71%), 8 (57%) had leg pain and sciatica, and 6 (43%) had back pain. Primary is typically a form of OSD while secondary usually occurs following a myelomeningocele repair or other type of spinal cord surgery History and Exam Tethered spinal cord is most commonly diagnosed in infancy by the discovery of a abnormality noticed on the skin of the back. The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies. Application of microsurgical technique for intraspinal lipoma tethered cord syndrome: report of 611 cases. It may not be possible for the syrinx to be fully removed, so the goal of surgery may be . WebRecurrent tethered cord syndrome (TCS) can lead to significant progressive disability in adults.
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