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. An umbilical hernia repair is a relatively routine surgery and takes about 20 to 30 minutes. Many recent reports of TCS in adult patients have grouped retethering patients with newly diagnosed ones without separately analyzing each entity and outcome. 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). government site. Epub 2015 Nov 26. Learn about the many ways you can get involved and support Mass General. 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. His motor weakness marginally improved after SSO; however, he did not improve sufficiently to be able to walk by himself. 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 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. sharing sensitive information, make sure youre on a federal [2], Dermoid cyst should be completely removed together with cyst wall as much as possible, cystic wall residue is easy to cause the recurrence of cyst, although decreased volume of cyst can relieve the symptom of tethered, characteristics of dermoid cyst may lead greater possibility to TCS than lipoma. 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. Physical therapy. Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. SSO was performed at the level of T12 or L1 (Fig. 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan, 2Department of Orthopedic Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan, 3Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan, 4Department of Orthopedic Surgery, Konan Kosei Hospital, Aichi, Japan, 5Department of Orthopedic Surgery, Aichi Medical University, Aichi, Japan, 6Department of Orthopedic Surgery, Hamamatsu Medical University, Shizuoka, Japan. 11 Then, temporary rods were fixed in place for column stability while we performed the osteotomy. Twenty-eight patients remained in stable clinical condition. Surgical management of tethered spinal cord in adults: report of 54 cases. Prompt surgical treatment is often necessary to avoid permanent sequelae. 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. 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. Learn about career opportunities, search for positions and apply for a job. Therefore, it is necessary to remove contents within the cyst and to reduce the size of the cyst as far as possible, followed by free cystic wall, and then to minimize the stretching of the nerve tissue. In patients demonstrating 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. Overall, it remains unclear which procedure is preferable for TCS in adults: untethering surgery or SSO. 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. WebConclusions: Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis. 4 8. To ascertain the results of surgery in adult patients with this anomaly, the authors undertook a retrospective review of 34 cases. 3. This can lead to infection if the incision is on the low back. The operation curative effects for TCS with different symptoms. An official website of the United States government. Garceau theorized that tension on the . (A) A 37-year-old male patient with a lumbar spinal lipoma at L3/L4 level. Going from horizontal to vertical felt like being hit in the back of the head with a baseball bat. Chern JJ, Dauser RC, Whitehead WE, Curry DJ, Luerssen TG, Jea A. Spine (Phila Pa 1976). 3 Physical therapy. Accessibility The end of the spinal cord normally hangs and moves freely inside the spinal column. 2015-1002-02-09; grant recipient: XK). 2014; 192:221-7. . Tethered cord syndrome is a stretch-induced functional disorder associated with the fixation (tethering) effect of inelastic tissue on the caudal spinal cord, limiting its movement. J Neurosurg. Patients who underwent surgery for TCS secondary to posttraumatic or postinflammatory conditions were not included in this study. Log in now and start In adults, dethetering of the spinal cord . For patients treated conservatively, follow-up information could be obtained in 33 of 42 patients. Abbreviation: TCS = tethered cord syndrome. JG, XK, and ZL have contributed equally to the article. Some have ended up completely paralyzed from the surgeries. One patient in the untethering surgery group underwent SSO because the symptoms worsened 1year after untethering. WebRecurrent tethered cord syndrome (TCS) can lead to significant progressive disability in adults. World J Clin Cases. Tethered Cord Syndrome in Children and Adults. The patient with tight terminal filum underwent untethering surgery. Conclusions: Physicians: To refer a patient, call 410-955-7337. 10 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 . J Neurosurg Spine. Among them, lipoma-oriented TCS was found in 10 cases of patients, of which including 2 cases showing symptoms improvement, 8 cases showing symptom stabilization, no case got worse. J Neurosurg Spine. Eleven patients underwent untethering surgery, and 3 patients underwent SSO surgery. Syringomyelia is a disorder in which a fluid-filled cyst (called a syrinx) forms within the spinal cord. Surgery is lengthier in adults since they have thicker backs than children do. 8 The https:// ensures that you are connecting to the government site. The .gov means its official. (A) Preoperative lateral radiograph. 7 For all patients, pain was the most common major complaint. In adults, symptoms of tethered cord usually develop slowly. (B) Preoperative sagittal T2-weighted magnetic resonance imaging (MRI) scan shows a low-placed conus medullaris and terminal filum connected with a subcutaneous lipomyelomeningocele at the S1S2 level. Garg K, Tandon V, Kumar R, et al. WebAdult Tethered Cord Release - cns.org Open Access The Nexus online library is your free comprehensive resource for neurosurgical cases and approaches. The diagnosis of TCS is made with a high degree of clinical suspicion. 3 The patient was a 36-year-old man who had undergone myelomeningocele repair during infancy. Besides, there was no deteriorated case. To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). 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. To the best of our knowledge, there have been no reports on comparisons of the surgical results of the two procedures for TCS in adults. 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. . 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. Bethesda, MD 20894, Web Policies As a result, the spinal cord cant move freely Hoffman HJ, Hendrick EB, Humphreys RP. Surgery was recommended for patients with symptoms only. 9 13. Httmann S, Krauss J, Collmann H, et al. According to Hoffman grading system, the neurologic symptoms were improved in 22 patients (27%) and stabilized in 60 patients (73%). Your child may need an operation to help the spinal cord move freely. Long-term surgical results and patient outcome ratings were encouraging. The mean operation time was 220.2109.0 minutes for untethering surgery and 399.59.6 minutes for SSO; as these numbers clearly indicate, the time was significantly longer for the SSO group (p=0.01). 1B). The patient with symptoms following resection of a lipomyelomeningocele: do increases in the lumbosacral angle indicate a tethered spinal cord? Klekamp J. Tethered cord syndrome in adults. Surg Neurol. Definition. Received 2015 Aug 6; Accepted 2015 Sep 22. tethered cord syndrome, adult, untethering, spine-shortening osteotomy. The spinal cord tension was relieved after surgery as shown by preoperative MRI. Cui ZG, Xiu B, Xiao K, et al. The site is secure. Throughout the entire surgery, the care team will check how your childs spinal cord is working properly. 6 This is not associated with spina bifida, but may occur in patients with Chiari malformation. This can lead to infection if the incision is on the low back. Thus, additional prospective randomized large-scale studies are needed to confirm our results. Surgical options include: Suboccipital decompression for Chiari malformation. But in Case 3, the paraesthesia and weakness of lower extremities were persistent, and there Shiro Imagama, none Following postoperative lumbar spine reexamination by MRI, corresponding results were as follows: postoperative position of coni medullaris was relatively improved than that of the preoperative, and the width was broadened to the posterior wall of the thecal sac; the tension of filum terminale was decreased, filum terminale, and cauda equina showed relatively normal morphology, filum terminale apart from the posterior wall of the thecal sac was found in a part of cases of TCS patients; and if there was occupying lesions, volumes of occupying lesions showed decreased trends and indicated alleviated adhesion or compression to the coni medullaris or cauda equina. 2018 Apr-Jun;13(2):264-270. doi: 10.4103/1793-5482.228566. 10 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. Symptoms in patients with combined and lipomyelomeningocele TCS was relatively heavier, fat surrounded multiple bundle of cauda equina, dissociating of the cauda equina was therefore more difficult, and it was difficult to be completely removed, also accompanied with subsidiary-injury recurrence of TCS, finally resulting in poor prognosis and none significant improvement of symptoms.[17]. The duration of symptoms was significantly longer in the SSO group (2512.4 years) than in the untethering surgery group (8.26.3 years; p=0.01). 7 7 [] This entity was first described by Garceau (1953) and Surgical treatment is the only effective method to relieve occupying, loose adhesions, and compression, its main purpose is to lift the tethered to reduce the stretching of the taper tension, and thus to control further development of symptoms and to reduce further damage to the nerve function. By clinical analysis of 611 cases of patients with lipoma-oriented TCS, Cui et al[19] proved that patients with no symptoms and mild symptoms obtained satisfactory postoperative curative effects, according to Hoffman grading evaluation of preoperative and postoperative changes of symptoms, whereas the curative effect was relatively poor in patients showing severe symptoms after operation, early surgical treatment was therefore recommended to obtain better curative effect. Abstract. 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 . Repeated bladder infections. The attached tissue limits the movement of the spinal cord within the spinal column and causes an abnormal stretching of the spinal cord and impairment of blood flow to the nerve tissue. Careers. 5 tethered spinal cord constipation . 11. Suite F4300. The clinical records were reviewed for preoperative symptoms, duration of symptoms, complications, and neurologic improvements. Tethering can happen before or after birth in children and adults; and most often occurs in the lower (lumbar) level of the spine. Lower back pain. All the 82 cases of patients received nerve electrophysiology monitoring assisted microsurgery. Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. eCollection 2020 Mar. WebSpray Foam Equipment and Chemicals. Six hospitals in our spine group were included. Tethered cord syndrome: a review of the literature from embryology to adult presentation. National Library of Medicine [6] In 1981, Yamada et al[7] found in animal studies that the role of mitochondrial metabolism was reduced in the termination of spinal cord, the greater the tension, the longer the time, and the more serious the nervous dysfunction was. Improvement in clinical features was compared in the untethering and SSO groups (Table 3). 10 In adults, surgery to free (detether) the spinal cord can reduce the size and further development of cysts in the cord. Symptoms often stabilize or improve after surgery; 6 however, retethering (along with renewed symptoms) may reoccur especially during rapid A potential predictor of long-term bladder function after detethering surgery in patients with tethered cord syndrome. A representative case of spine-shortening osteotomy. A. At surgery, the spinal cord was freed from its attachments to the dura, and the symptoms resolved [13]. A total of 32 consecutive adult patients underwent untethering surgery for secondary tethered cord syndrome in our department from January 2008 until December 2018. Naoki Ishiguro, none Thoracolumbar surgery for degenerative spine diseases complicated with tethered cord syndrome: A case report. Tethered cord syndrome is a rare neurological condition in which the spinal cord is attached (tethered) to the surrounding tissues of the spine. eCollection 2020. Safe Care CommitmentGet the latest news on COVID-19, the vaccine and care at Mass General.Learn more. J Surg Case Rep. 2020 Mar 24;2020(3):rjaa041. The 14 patients (10 men, 4 women) with a mean age of 37.712.5 years (range, 19 to 53 years) had undergone surgery for adult TCS between 1994 and 2010. Garceau GJ. Object: As with any surgery, tethered cord surgery has risks and complications. Tethered cord release surgery is a type of surgery to reduce or remove the tissue that is preventing the spinal cord from moving freely. Her curves when checked were Top - 23 and bottom - 23. Surgery in adult patients with a tethered cord syndrome should be reserved for those with symptoms. To investigate effects of surgical treatment on adult TCS, a retrospective analysis of 82 adult patients with TCS treated by surgery was conducted between March 2005 and December 2015. If re-tethering does occur, your child may need another surgery to fix it. Hertzler DA 2nd, DePowell JJ, Stevenson CB, et al. Disclaimer. [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. In general, although pain is an initial symptom, it improves significantly after surgery.1 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. 17. WebIn adults, symptoms of tethered cord often develop slowly, but they can become quite severe. 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. Yamada S, Lonser R R. Adult tethered cord syndrome. 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. Stretching and tension, especially in a growing child, can cause neurologic damage. [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. Unauthorized use of these marks is strictly prohibited. After untethering surgery, CSF leakage, neurologic deterioration, hematoma, difficult wound healing, and meningitis have been reported (Table 5).1 Bulbocavernosus reflex (BCR) monitoring is used to assess the integrity of urinary and bowel function. 5 Besides, there was no case of infection, new onset of nerve injury or second TCS postoperatively. Unauthorized use of these marks is strictly prohibited. 2. Tethered cord is usually present at birth . The author analyzes data obtained in patients who were diagnosed with a tethered cord in adulthood and either underwent surgical or conservative therapy between 1991 and 2009. Figure 1A shows a 37-year-old male patient with a lumbar spinal lipoma at L3/L4 level. to analyze our web traffic. The laminae and transverse processes of the vertebrae at T12 and L2 were resected, and the pedicle screws were placed bilaterally at these vertebrae. Urologic dysfunction subjectively improved in 36% of the patients with that complaint. The surgical scheduler will work with you and family to coordinate a surgical date that fits best into your and your childs schedules. [2] The tumor compression of the cone and the tail is one of the main causes for the tethered cord. However, to use this type of procedure for spinal cord tethering is new and extremely rare, says Theodore . Methods: Neurosurg Focus. Selcuki M, Mete M, Barutcuoglu M, et al. Medicine (Baltimore). 13 Therefore, untethering surgery is not always a promising procedure.11. 2021 Feb 16;88(3):637-647. doi: 10.1093/neuros/nyaa491. Tremors or spasms in the leg muscles. However, some neurological and motor impairments may not be fully correctable. Surgery to detach the spinal cord from the sheath. 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 . These back pains were treated conservatively with oral analgesic agents. Fatty Filum Terminale. Post-operative radiotherapy for recurrent dermoid cysts of the spine: a report of 3 cases. Because the incision is lower on the back around a part of the spine that does not bear your childs body weight, pain is limited. 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. However, Some patients may be misdiagnosed as having sciatica, a more common source of lower back . Altered sensation (numbness or paresthesia) and bladder and/or fecal dysfunction were the most common complaints among 11 patients (79%). 8600 Rockville Pike 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. Your child will also need a COVID-19 PCR test 48 hours (2 days) before surgery. The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review. Second, a standardized surgical protocol was not used, and the surgical approach was left to the discretion of the attending surgeon. 6 Results. 5 Clipboard, Search History, and several other advanced features are temporarily unavailable. Milano JB, Barcelos ACES, Onishi FJ, Daniel JW, Botelho RV, Dantas FR, Neto ER, de Freitas Bertolini E, Mudo ML, Brock RS, de Oliveira RS, Joaquim AF. Perioperative complications are another concern in adult TCS. Explore fellowships, residencies, internships and other educational opportunities. One patient showed worsening of sensory function and another patient complained of a new lower back pain in the SSO group. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. During the first 24 hours, your child will remain flat on their back to prevent fluid leak from the incision. On Oct. 18, 2017, 10-month-old Eva was taken to an operating room at Children's Hospital of Philadelphia, where Dr. Chen performed surgery to free Eva's spinal cord, and Jesse Taylor, MD, Chief of the Division of Plastic, Reconstructive and Oral Surgery, removed two of the lipomas. In a small percentage Back and leg pain improved in 50 and 63% of patients, respectively. Log in | Become a member | Create an Account If you are unable to log in contact membership@cns.org Epub 2012 Jul 13. Tethered cord syndrome in adults: experience of 56 patients. It may not be possible for the syrinx to be fully removed, so the goal of surgery may be . Fioricet was the first migraine medication I was prescribed.
