Out Come of Surgical Management of Tethered Cord Syndrome

Authors

  • Dr. M. Ajmal Khan Lahore General Hospital, Lahore
  • Dr. Mukhtiar Ahmad Lahore General Hospital, Lahore
  • Dr. Fauzia Sajjad Lahore General Hospital, Lahore
  • Dr. Sundas Ali Lahore General Hospital, Lahore

Keywords:

Tethered cord syndrome, neurological outcome, back pain, motor function, urinary incontinence

Abstract

Objective: To determine neurological outcome after surgical management of tethered cord syndrome.

Material and Methods: This descriptive study was conducted in the department of Neurosurgery, Lahore General Hospital Lahore. Over a period of Three Years From 2012 to 2014. Study Comprised of Fifty Patients after fulfilling the inclusion and exclusion criteria.

Results: The mean age of the patients was 36 ± 10 Years There were 30 (60.0%) male and 20 (40.0%) female patients. There was improvement in neurological status. The distribution of improvement in neurological status, revealed 35 (70.0%) patients had improvement in back pain, 18 (36.0%) improved motor function and 17 (34.0%) improved urinary incontinence.

Conclusion: It is concluded from this study that back pain, motor function and urinary incontinence improve postoperatively in the majority of patients. The rate of symptomatic improvement was greatest for back pain, followed by motor, and then urinary improvement.

Abbreviations: TCS: Tethered Cord Syndrome. ATCS: Adult Tethered Cord Syndrome.

Author Biographies

Dr. M. Ajmal Khan, Lahore General Hospital, Lahore

Department of Neurosurgery

Dr. Mukhtiar Ahmad, Lahore General Hospital, Lahore

Department of Neurosurgery

Dr. Fauzia Sajjad, Lahore General Hospital, Lahore

Department of Neurosurgery

Dr. Sundas Ali, Lahore General Hospital, Lahore

Department of Neurosurgery

References

1. Ahed S, El-Hefnawy, Bassem SW. Effect of detethering on bladder function in children with myelomeningocele: Urodynamic evaluation. J Pediatr Neurosci. 2009; 4 (2): 70-.
2. Daszkiewicz P, Barszez S, Roszkowski M, Maryniak A. Tethered cord syndrome in children – impact of surgical treatment on functional neurological and urological outcome. Neurol Neurochir Pol. 2007; 41: 427-35.
3. Aufschnaiter K, Fellner F, Wum G. Surgery in adult onset tethered cord syndrome (ATCS): review of literature on occasion of an exceptional case. Neurosrug Rev. 2008; 31: 371-83.
4. Al-Holou WN, Muraszko KM, Garton HJ, Buchman SR, Maher CO. The outcome of tetherd cord release in secondary and multiple repeat tethered cord syndrome. J Neurosurg Pediatr. 2009; 4: 28-36.
5. Tseng JH, Kuo MF, Kwang TY. Outcome of untethering for symptomatic spina bifida occulta with lumbosacral spinal cord tethering in 31 patients: analysis of preoperative prognostic factors. Spine J. 2008; 8: 630-8.
6. Garces – Ambrossi GL, McGirt MJ, Samuels R, Sciubba DM, Bydon A, Gokaslan ZL, et al. Neurological outcome after surgical management of adult tethered cord syndrome. J Neurosurg Spine, 2009; 11: 304-9.
7. Akay KM, Er?ahin Y, Cakir Y. Tethered cord syndrome in adults. Acta Neurochir (Wien), 2000; 142: 1111–1115.
8. Hendrick EB, Hoffman HJ, Humphreys RP. The tethered spinal cord. Clin Neurosurg. 2003; 30: 457–463.
9. Hoffman HJ, Hendrick EB, Humphreys RP: The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Childs Brain, 2006; 2: 145– 155.
10. McLone DG. The adult with a tethered cord. Clin Neurosurg. 1996; 43: 203–209.
11. Yamada S, Lonser RR. Adult tethered cord syndrome. J Spinal Disord. 2003; 13: 319–323.
12. Fuchs A. Ueber Beziehungen der Enuresis nocturna zu Rudementarformen der Spina bifida occulta (Myelodysplasie). Wien Med Wochenschr. 2010; 80: 1569–1573.
13. Lichtenstein BW. Spina dysraphism: spina bifida and myelo-dysplasia. Arch Neurol Psychiatry, 2000; 44: 792–809.
14. Garceau GJ. The filum terminale syndrome (the cordtraction syndrome). J Bone Joint Surg Am. 2003; 35-A: 711–16.
15. Barson AJ. The vertebral level of termination of the spinal cord during normal and abnormal development. J Anat. 2000; 106: 489–97.
16. Pang D, Wilberger JE Jr. Tethered cord syndrome in adults. J Neurosurg. 2002; 57: 32–47.
17. Raghavan N, Barkovich AJ, Edwards M, Norman D. MR imaging in the tethered spinal cord syndrome. AJR Am J Roentgenol. 1989; 152: 843–52.
18. Warder DE, Oakes WJ. Tethered cord syndrome: the low – lying and normally positioned conus. Neurosurgery, 1994; 34: 597–600.
19. Yamada S, Knerium DS, Mandybur GM, Schultz RL, Yamada BS. Pathophysiology of tethered cord syndrome and other complex factors. Neurol Res. 2004; 26: 722–26.
20. Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA. Spina bifida outcome: a 25 – year prospective. Pediatr Neurosurg. 2001; 34: 114–120.
21. Bowman RM, Boshnjaku V, McLone DG. The changing incidence of myelomeningocele and its impact on pediatric neurosurgery: a review from the Children's Memorial Hospital. Childs Nerv Syst. 2009; 25: 801– 806.
22. Bowman RM, Mohan A, Ito J, Seibly JM, McLone DG. Tethered cord release: a long-term study in 114 patients. J Neurosurg Pediatr. 2009; 3: 181–7.
23. Lee GY, Paradiso G, Tator CH, Gentili F, Massicotte EM, Fehlings MG. Surgical management of tethered cord syndrome in adults: indications, techniques, and long-term outcomes in 60 patients. J Neurosurg Spine, 2006; 4: 123–31.
24. McLone DG. The adult with a tethered cord. Clin Neurosurg. 1996; 43: 203–209.
25. Phuong LK, Schoeberl KA, Raffel C. Natural history of tethered cord in patients with meningomyelocele. Neurosurgery, 2002; 50: 989–995.
26. Cochard LR, Netter FH. Netter’s Atlas of Human Embryology, ed 1. Teterboro, NJ. Icon Learning Systems, 2002.
27. Larsen WJ. Human Embryology, ed 3. New York: Churchill Livingstone, 2001.
28. Lew SM, Kothbauer KF. Tethered cord syndrome: an updated review. Pediatr Neurosurg. 2007; 43: 236–48.
29. Reimann AF, Anson BJ. Vertebral level of termination of the spinal cord with report of a case of sacral cord. Anat Rec. 1999; 88: 127–38.
30. Pinto FC, Fontes RB, Leonhardt MdeC, Amodio DT, Porro FF, Machado J. Anatomic study of the filum terminale and its correlations with the tethered cord syndrome. Neurosurgery, 2002; 51: 725–30.
31. Roy MW, Gilmore R, Walsh JW. Evaluation of children and young adults with tethered spinal cord syndrome. Utility of spinal and scalp recorded somatosensory evoked potentials. Surg Neurol. 1996; 26: 241–48.
32. Kale SS, Mahapatra AK. The role of somatosensory evoked potentials in spinal dysraphism – do they have a prognostic significance? Childs Nerv Sys. 1998; 14: 328–32.
33. Hoffman HJ, Taecholarn C, Hendrick EB, Humphreys RP. Management of lipomyelomeningoceles. Experience at the Hospital for Sick Children, Toronto. J Neurosurg. 2005; 62: 1–8.

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Published

2015-12-25

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