Document Detail


Surgical management of tethered cord syndrome in adults: indications, techniques, and long-term outcomes in 60 patients.
MedLine Citation:
PMID:  16506479     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The adult presentation of tethered cord syndrome (TCS) is well recognized but continues to pose significant diagnostic and management challenges. The authors performed a retrospective study of clinical outcomes after neurosurgical intervention in 60 adults with TCS. METHODS: All patients who underwent detethering surgery for caudal cord tethering at Toronto Western Hospital between August 1993 and 2004 were identified. Their clinical charts, operative records, and follow-up data were reviewed. Detethering procedures were performed in 62 patients (age range 17-72 years) for TCS of various origins. Long-term (mean 41.5 months) follow-up data were obtained in 60 patients. The tethering lesions were tight terminal filum in 29 patients, postrepair myelomeningocele in 15, lipomyelomeningocele/lipoma in nine, split cord malformation in four, and arachnoidal adhesions in three. Fifty-nine patients presented with progressive pain and/or neurological dysfunction. One patient underwent prophylactic sectioning of the terminal filum. Most patients (71%) had bladder dysfunction at presentation. Microsurgical release of the tethered cord was performed in each case while using multimodality intraoperative neurophysiological monitoring. The most common complication was cerebrospinal fluid leakage, which occurred in nine patients and was managed by reinforcement sutures in four patients, temporary external drainage in three, and the placement of a lumboperitoneal shunt in two. Infective complications included superficial wound infection in three patients, meningitis in one, and urinary tract infection in one. One patient who had undergone multiple previous intradural procedures experienced worsened foot weakness postoperatively. Another patient experienced temporary unilateral lower-limb numbness. At follow up, improvement was noted in the majority of patients presenting with back (78%) and leg (83%) pain. Improvement was more likely in patients with preoperative motor weakness than in those with sensory deficits. Overall, neurological status was improved or stabilized in 90% of patients. Subjective improvement in bladder function was noted in 50% of patients with bladder dysfunction at presentation. CONCLUSIONS: Surgery in adult patients with TCS is safe and effective for improving pain and neurological status in the majority of patients; however, patients who have undergone previous intradural detethering procedures in general fare less well, and considerable judgment is required in their management.
Authors:
Gabriel Y F Lee; Guillermo Paradiso; Charles H Tator; Fred Gentili; Eric M Massicotte; Michael G Fehlings
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Spine     Volume:  4     ISSN:  1547-5654     ISO Abbreviation:  -     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-03-01     Completed Date:  2006-03-14     Revised Date:  2009-03-05    
Medline Journal Info:
Nlm Unique ID:  101223545     Medline TA:  J Neurosurg Spine     Country:  United States    
Other Details:
Languages:  eng     Pagination:  123-31     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Age of Onset
Aged
Female
Humans
Male
Microsurgery*
Middle Aged
Neural Tube Defects / complications,  diagnosis,  pathology,  surgery*
Neurosurgical Procedures / adverse effects,  methods*
Postoperative Complications
Retrospective Studies
Sciatica / etiology
Treatment Outcome
Urinary Bladder / physiology
Urinary Incontinence / etiology,  surgery
Comments/Corrections
Comment In:
J Neurosurg Spine. 2009 Jan;10(1):79-80; author reply 80-1   [PMID:  19119938 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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