A total of 32 consecutive adult patients underwent untethering surgery for secondary tethered cord syndrome in our department from January 2008 until December 2018. WebIntroduction. We offer diagnostic and treatment options for common and complex medical conditions. Cui ZG, Xiu B, Xiao K, et al. Tethered Cord Syndrome (TCS) is a broad term that encompasses both congenital (primary) and acquired (secondary) pathologies that anchor, elongate and tension the spinal cord[1] The spinal cord fixation produces mechanical stretch, distortion, and ischemia with daily activities, growth, and development[2] This prevents the spinal cord from freely moving, which then increases . Tethered cord syndrome treatment. Pathology and treatment of tethered cord syndrome with lipoma. We understand it may be overwhelming to hear that your child has a tethered spinal cord. 8600 Rockville Pike Syringomyelia is a disorder in which a fluid-filled cyst (called a syrinx) forms within the spinal cord. School-age children are typically out of school for 2 weeks. Disclaimer. Tremors or spasms in the leg muscles. Because neurological deficits are generally irreversible, early surgery is recommended. 1B). Epub 2015 Nov 26. what is the "golden" rule regarding third party billing? The types of lipomyelomeningocele/lipoma (following Chapman classification14) were dorsal type (present in 5 patients), transitional type (5 patients), and caudal type (3 patients). His motor weakness marginally improved after SSO; however, he did not improve sufficiently to be able to walk by himself. Bristow RG, Laperriere NJ, Tator C, et al. The .gov means its official. Liu JJ, Guan Z, Gao Z, et al. Some patients may be misdiagnosed as having sciatica, a more common source of lower back . For more information about these cookies and the data sharing sensitive information, make sure youre on a federal Your childs urinary catheter will be removed. He underwent SSO 1.5 years after untethering surgery. In contrast, fusion surgery in SSO might lead to adjacent segment disease that may require subsequent surgery in the long term after SSO. A conservative approach is warranted, however, in adult patients without neurological deficits. This is called tethered cord. Data is temporarily unavailable. MeSH terms Typically, there is also a short filum and, as a result of both anomalies, a tethered cord. Garceau GJ. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. To ascertain the results of surgery in adult patients with this anomaly, the authors undertook a retrospective review of 34 cases. A T12 to L1 diskectomy and L1 upper one-third vertebral body resection were performed thereafter. your express consent. Patients needing surgery for adult TCS are relatively young, so this postoperative complication would be a serious disadvantage of SSO for them. After surgery, all patients were followed up for an average of 2.5 years. Only 5 of the conservatively treated patients experienced clinical deterioration over time; in 4 of these individuals with deterioration, surgery had been recommended but was refused by the patient. Httmann S, Krauss J, Collmann H, et al. This can cause the spinal cord to stretch out as the spine grows, leading to possible nerve damage, pain and other symptoms. Untethering surgery was performed in 11 patients, and SSO was performed in three patients as initial surgeries for adult TCS in our institutions. Over time, the syrinx can get bigger and can damage the spinal cord and compress and injure the nerve fibers that carry information to the brain and from the brain to the rest of the body. A nurse will call you for your childs anesthesia screening 1-2 days before their scheduled surgical date. 5 All patients were followed up, no death occurred. Note: Results are the number of patients with improvement/the number of patients with each symptom preoperatively. Conclusions: Surgery was recommended for patients with symptoms only. 5 Wang XG, Zhou YD, Ji SJ, et al. The lower half of the T12 lamina, the bilateral lower articular processes at T12, and the bilateral L1 superior articular processes were resected, and the bilateral L1 pedicles and bilateral transverse processes were then removed. 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. First, it was a retrospective review of a small number of patients, due to the fact that the number of adult patients with TCS is relatively low, so securing a large number of patients for the study (especially patients with SSO) was difficult even though the study was a multicenter one. In addition, some patients refused to take surgical treatment, and their symptoms were further aggravated or new symptoms appeared followed by telephone or outpatient follow-up. As a result, the spinal cord cant move freely It is pulled tightly at the end, reducing blood ow to spinal nerves and causing damage to the spinal cord from both the stretching and the decreased blood supply. Tethering can happen before or after birth in children and adults; and most often occurs in the lower (lumbar) level of the spine. Complications include infection, bleeding, and damage to the spinal cord or myelomeningocele, which may result in decreased muscle strength or bladder or bowel function. Epub 2017 Feb 13. Of 40 cases without occupying lesions of TCS, the symptoms were improved in 14 cases and stabilized in 26 cases, there was no deteriorated case. A syringo-subarachnoid shunt to drain the cyst. tethered spinal cord constipation . To be included, patients (1) had to be>18 years old at the time of surgery and (2) had to have undergone spinal surgery for TCS. For larger cysts, it is not possible to force the free capsule wall directly, because the cone and the cauda equina are in a high tension state, and any tiny stretching is likely to cause further damage. WebWhen a portion of the spinal cord becomes attached to lesions within the spinal column, excess strain can cause signs and symptoms such as pain, motor deficits, sensory deficits, bladder dysfunction, and bowel dysfunction. Conclusions: In our study, in patients with severe Hoffman grading and without satisfied remission of symptoms, there were tendencies of longer medical history, more complications, and complicated symptoms; and for patients with relatively short medical history, Hoffman grading was shown to be mild and postoperative symptoms were improved obviously, which were similar with the above conclusions. Management of adult tethered cord syndrome: our experience and review of literature. The combined complication rate of this surgery is usually 1-2%. 20. The categories of tethering lesions were tight terminal filum in 1 patient, lipoma in 5 patients, and lipomyelomeningocele in 8 patients. At surgery, the spinal cord was freed from its attachments to the dura, and the symptoms resolved [13]. 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 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. Learn about the many ways you can get involved and support Mass General. This prevents the spinal cord from moving to keep up with the lengthening of the spine as it grows. 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. WebA tethered spinal cord occurs when the spinal cord is attached to tissue around the spine, most commonly at the base of the spine. 9 Patients with such complex pathologies have been found to have a 9 to 50% chance of worsening pain and sensorimotor deficits after untethering.7 Unlike pediatric patients, adults experience degenerative changes that further complicate treatment.5 The clinical records were reviewed for preoperative symptoms, duration of symptoms, complications, and neurologic improvements. The percentage of patients with prior surgery was higher in the SSO group than in the untethering group, although the difference was insignificant. 6. The authors prefer to limit bathing to a sponge bath until the patient is seen in clinic 1 week later. Koji Sato, none 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. Tethered cord is usually present at birth . The https:// ensures that you are connecting to the Tethered cord syndrome is a rare neurological condition. J Neurosurg Spine. 5 The mean age of the patients was 46 13 years (range 23-74 . 2nd ed. The site is secure. Tethered cord syndrome (TCS) is basically a condition where anchorage of a part of the spinal cord, most commonly the area of the conus, by some inelastic structure, which results in functional dysfunction involving the adhered segment of the spinal cord or at times segments beyond that. Funding/support: This study was supported by Peking Union Medical College Youth Research Funds (2016) (project no. The site is secure. Application of microsurgical technique for intraspinal lipoma tethered cord syndrome: report of 611 cases. 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. 6 eCollection 2020. The care team will place a urinary catheter to help urine flow out of your childs body during and after surgery. bDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA. Duraplasty using substitute materials was performed at the close of surgery. Clipboard, Search History, and several other advanced features are temporarily unavailable. Rev. There were no significant differences in age, sex, types of preoperative symptoms, or duration of follow-up between the two groups. The surgical procedure performed at L1 is described below. 11 Miyakoshi et al reported complete clinical recovery without complications in 2009, which led to the hope that SSO would be the way to reduce perioperative complications and provide better neurologic outcomes.10 Although Kokubun et al also reported good clinical results after SSO in 2011,11 there have been no reports until now of a comparative study or review of these two procedures. 10 6 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. [16] On the whole, patients with filar TCS had the lightest symptoms, corresponding surgery was relatively easy, and prognosis in the follow-up period was relatively better after removing filum terminale. Surg Neurol. Murata Y, Kanaya K, Wada H, et al. A potential predictor of long-term bladder function after detethering surgery in patients with tethered cord syndrome. Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work. Scheduled medications for pain relief during the early post-operative period at home include: There may be additional pain medications given as needed for breakthrough pain. Depending on your childs age, symptoms of tethered cord syndrome vary. 11 It is often associated with spina bifida and scoliosis. It may not be possible for the syrinx to be fully removed, so the goal of surgery may be .