10 13 Preoperative shorter duration of symptoms is associated with favorable clinical outcome because the pathophysiology of TCS is associated with impaired oxidative metabolism in the affected spinal cord.7 Klekamp[14] advocated that for small lipoma and cone did not show obvious compression, the symptom is mainly caused by tethered, simply releasing of the tethered is suitable to prevent postoperative adhesion and not to destroy lipoma; and for larger lipoma compressed the conus medullaris, decreasing the volume of lipoma from internal, retaining the capsule, and sewing up the incision will be more effective to reduce the possibility of adhesion. The types of lipomyelomeningocele/lipoma (following Chapman classification14) were dorsal type (present in 5 patients), transitional type (5 patients), and caudal type (3 patients). [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. 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: What to Expect for Your Child's 2022 Oct 6;10(28):10375-10383. doi: 10.12998/wjcc.v10.i28.10375. The care team will place a urinary catheter to help urine flow out of your childs body during and after surgery. Of these patients, there were 34 males and 48 females, with an age range of 18 to 47 years (average age, 31.6 years), and average disease course of 6.7 years. tethered cord Intraoperative feasibility of bulbocavernosus reflex monitoring during untethering surgery in infants and children. 7 214-456-2444. Tethered cord syndrome: surgical outcome of 43 cases Tethered cord syndrome: an updated review. Of 32 cases with tethered spinal cord caused by dermoid cyst and epidermoid cyst, the symptoms were improved in 6 cases. In general, although pain is an initial symptom, it improves significantly after surgery.1 This can cause the spinal cord to stretch out as the spine grows, leading to possible nerve damage, pain and other symptoms. There were 10 cases of lumbosacral intraspinal canal lipoma (12%), 32 cases of (39%) dermoid cyst and epidermoid cyst, and 40 cases (49%) without occupying lesions of tethered spinal cord. An umbilical hernia repair is a relatively routine surgery and takes about 20 to 30 minutes. Careers. Statistical analyses were performed using SPSS version 18 (SPSS Inc., Chicago, Illinois, United States). Changes of symptoms were associated with the course of disease; patients with relatively shorter disease course were shown to have a mild Hoffman grading, whereas patients with relatively longer disease course were indicated to have a severe Hoffman grading. All patients were followed up, no death occurred. The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Pathophysiology of tethered cord syndrome and similar complex disorders. There are different types of tethered cord. One of the most common complications related to this surgery is wound infection, especially if the incision (cut into the skin) is made around the low back. Klekamp J. Tethered cord syndrome in adults. Please try after some time. J Neurosurg. We understand it may be overwhelming to hear that your child has a tethered spinal cord. The preoperative pathology was lipomeningocele in all SSO group and lipoma or tight terminal filum in the untethering group. JG, XK, and ZL have contributed equally to the article. The care team will talk with you before discharge (when your child goes home after surgery) about signs and symptoms of common complications, such as infection and/or cerebrospinal fluid leak. Yamada S, Won D J, Pezeshkpour G. et al. Clinical features at presentation are summarized in Table 1. Second, a standardized surgical protocol was not used, and the surgical approach was left to the discretion of the attending surgeon. 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 . 19. 6 Moreover, complications, such as cerebrospinal fluid (CSF) leakage and neurologic deterioration, have been frequently reported.1 Safe Care CommitmentGet the latest news on COVID-19, the vaccine and care at Mass General.Learn more. WebHave you lie flat on your back for up to 72 hours to prevent cerebrospinal fluid from leaking around the spinal cord During your stay, the hospital staff will take steps to lower your A tethered cord release reduces or removes the . Abstract. Fatty Filum Terminale. When possible, the care team can plan surgery close to school vacations. Klekamp J. Tethered cord syndrome in adults. Tethered Cord Syndrome can be difficult to diagnose in babies and children since the symptoms may be subtle and insidious over time. A tethered cord may go undiagnosed until adulthood when sometimes complex and severe symptoms come on slowly over time. Conclusions: In the patients who had undergone myelomeningocele repair during infancy or previous untethering surgery, meticulous dissection was required to ensure complete release of the spinal cord because of extensive arachnoidal adhesions. The authors reviewed their institutional experience with the surgical management of adult TCS to assess the time course of symptomatic improvement, and to . 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. 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 10. Httmann S, Krauss J, Collmann H, et al. His preoperative symptoms were muscle weakness, gait disturbance, urinary and fecal dysfunction, and back and leg pain. Pelissou-Guyotat I, Sindou M, Pialat J, Goutelle A. Solmaz I, Izci Y, Albayrak B, Cetinalp E, Kural C, Sengul G, Gocmez C, Pusat S, Tuzun Y. Some people might continue to have Murata Y, Kanaya K, Wada H, et al. 2007;23(2):E11. Pediatric pathology all grown up - An interesting case of adult tethered spinal cord. Bulbocavernosus reflex (BCR) monitoring is used to assess the integrity of urinary and bowel function. Yamada S, Lonser R R. Adult tethered cord syndrome. Comparative Study of Untethering and Spine-Shortening Surgery for Tethered Cord Syndrome in Adults. 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]. Four patients (29%) underwent prior surgery for myelomeningocele repair during infancy, 2 (18.2%) in the untethering group and 2 (66.7%) in the SSO group; 1 of these 4 patients underwent untethering surgery at 7 years of age. to analyze our web traffic. 2007 Mar;6(3):210-5. doi: 10.3171/spi.2007.6.3.210. After the tumor was removed, the dura mater spinalis with low tonus was closed by water, and the dura mater spinalis with high tonus was formed by the autogenous fascia. Patients who underwent surgery for TCS secondary to posttraumatic or postinflammatory conditions were not included in this study. Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. Now, to catluvr's post. 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. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Bristow RG, Laperriere NJ, Tator C, et al. Epub 2019 Oct 9. WebA 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. official website and that any information you provide is encrypted Definition. The authors have no conflicts of interest to disclose. Based on this small retrospective case series, SSO appears to provide clinical improvement at least comparable to that of the untethering procedure, especially in more challenging cases (complex malformations or revision surgery). Spinal cord infarction caused by sacral canal epidural steroid injection: A case report. Of 40 cases without occupying lesions of tethered spinal cord, the symptoms were improved in 14 cases. Naoki Ishiguro, none Tethered Cord Federal government websites often end in .gov or .mil. Preoperative motor deficits improved in 67% of the patients. Neurophysiologic intraoperative monitoring is when doctors place electrodes (wires with a sticker on one end) on your childs head, arms and legs. An adult tethered cord syndrome has also been described. Duraplasty using substitute materials was performed at the close of surgery. 2014; 192:221-7. . 2011 Jun 15;36(14):E944-9. We use cookies and other tools to enhance your experience on our website and WebAdult Tethered Cord Release - cns.org Open Access The Nexus online library is your free comprehensive resource for neurosurgical cases and approaches. [5] In 1976, Hoffman et al[6] reported 31 patients combined with conus medullaris after stretching slenderization, corresponding nerve function were improved following cutting off the tensive and thicker and filum terminale; besides, syndrome that the conus medullaris was stretched was named tethered spinal cord syndrome, has been used to describe for nervous dysfunction caused by conus medullaris stretching. Untethering (tethered cord release) is the gold standard treatment for TCS. Patients needing surgery for adult TCS are relatively young, so this postoperative complication would be a serious disadvantage of SSO for them. 8 Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work. sharing sensitive information, make sure youre on a federal At Mass General, the brightest minds in medicine collaborate on behalf of our patients to bridge innovation science with state-of-the-art clinical medicine. Surgical effects were evaluated according to Hoffman grading system. With a recommendation for surgery this figure rose to 47% within 5 years. Search for Similar Articles 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. 8. Perioperative complications are another concern in adult TCS. [13] The growth of body weight and the use of hormones may cause the increase of lipoma and increased symptoms of TCS. 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. Postraumatic syringomyelia involves development of a fluid-filled cavity (called a cyst or syrinx) within the spinal cord following a spinal cord injury. WebA tethered spinal cord occurs when the spinal cord is attached to tissue around the spine, most commonly at the base of the spine. Generally, although surgical invasiveness is greater with SSO, this procedure could be considered as a viable alternative to untethering surgery in complicated adult TCS cases. Romagna A, Suchorska B, Schwartz C, Tonn J C, Zausinger S. Detethering of a congenital tethered cord in adult patients: an outcome analysis. Complications after spinal anesthesia in adult tethered cord - LWW Keyword Highlighting 10 TCS caused by different causes may have different curative effects following surgical treatment, for example, if TCS is induced by simply thickening filum terminale, the removal of filum terminale can get better operation results; if it is caused by myelomeningocele, which are usually combined with spina bifida, the operation is relatively complex and surgery is needed to be operated as soon as possible to protect the neurological function, the most important is to suture the dura completely and prevent further TCS.
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