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. Mohd-Zin SW, Marwan AI, Abou Chaar MK, Ahmad-Annuar A, Abdul-Aziz NM. (D) Postoperative sagittal T2-weighted MRI scan obtained 1year after surgery. Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients. Epub 2019 Oct 9. He presented with symptoms of lower back pain and legs pain. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Severe neurological deficits were rare. stretching. All the 82 cases of patients received nerve electrophysiology monitoring assisted microsurgery. WebFollowing a tethered cord release surgery, children are typically discharged in 1-2 days after surgery. Back and leg pain improved in 50 and 63% of patients, respectively. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 6 A potential predictor of long-term bladder function after detethering surgery in patients with tethered cord syndrome. WebPatients were examined by the same neurologist in a standardized fashion before and after surgery, and most were followed for at least 2 years postoperatively. 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. The child usually can resume normal activities within a few weeks. The use of decompressive segmental sublaminoplasty to treat myelopathy caused by lumbar stenosis in tethered cord syndrome. Patient age ranged from 19 to 75 years. The authors prefer to limit bathing to a sponge bath until the patient is seen in clinic 1 week later. The surgical release degrees for TCS with different pathologic changes are shown in Table 1. Tubbs RS, Bui CJ, Loukas M, Shoja MM, Oakes WJ. Urologic dysfunction subjectively improved in 36% of the patients with that complaint. Webtom kenny rick and morty characters. Abstract. 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. In addition, telephone interviews were obtained after a period of 8.6 years. Lower back pain. There were no significant differences in age, sex, and length of follow-up between the two groups. Mitsuhiro Kamiya, none 1. Horrion J, Houbart MA, Georgiopoulos A, et al. The average length of spine shortening was 23.3 mm. Treatment helps patients with tethered spinal cord syndrome have a normal life expectancy. We use cookies and other tools to enhance your experience on our website and Back pain: 14% better; 14% worse; leg pain: 11% better; 11% worse, Back pain: 78% better; 3% worse; leg pain: 83% better; 7% worse, Back pain: 77% better; leg pain: 47% better, 2% extradural hematoma/paraparesis; 5% revision CSF; 2% permanent neurologic worsening, 3% neurologic deterioration; 3% reoperation. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. Although it was difficult to compare clinical outcomes due to the small numbers of patients and heterogeneity, SSO might be preferable for improving the symptoms in adult TCS after considering these baseline differences. Typically, there is also a short filum and, as a result of both anomalies, a tethered cord. The most common presenting feature was pain, followed by weakness and incontinence. At present, the classification of lipoma-oriented TCS is confused, Arai et al[15] had classified it into 5 different kinds, including the dorsal, caudal, combined, filar, and lipomyelomeningocele; while it was subdivided into the lower conical, lateral conical, and upper conical by Wang et al. Problems with movement. Tethered Spinal Cord: What It Is, Symptoms & Treatment Get the latest news, explore events and connect with Mass General. Nineteen (86%) of 22 employed patients returned to work after surgery. Twenty-two (79%) of 28 patients called the operation a long-term success; 21 (75%) of 28 patients believed that they had significant postoperative improvement (and not just stabilization) in pain and/or neurological function. JG, XK, and ZL have contributed equally to the article. At surgery, the spinal cord was freed from its attachments to the dura, and the symptoms resolved [13]. The position in which it comes to rest in an adult (L1 or L2) is caused by the growth of the individual. Socio de CPA Ferrere. These guidelines often differ depending on surgical procedure. 2. Values of p<0.05 were considered to indicate statistical significance. But in Case 3, the paraesthesia and weakness of lower extremities were persistent, and there Please enable scripts and reload this page. Short-term results were determined within 3 months of surgery, whereas long-term outcomes (clinical recurrences) were evaluated using Kaplan-Meier statistics. 11 Miyakoshi et al reported that all of the neurologic symptoms in the subjects of one of their studies were relieved without complications after SSO,10 and it was hoped on the basis of that study that SSO would become a preferable approach for TCS in adults, but the number of patients in their study was small (n=3). Besides, there was no case of infection, new onset of nerve injury or second TCS postoperatively. Log in now and start Shinjo T, Hayashi H, Takatani T, Boku E, Nakase H, Kawaguchi M. J Clin Monit Comput. If the nerves are stretched, they may not work properly, and this can cause problems for your child. The effect of tethered cord release on coronal spinal balance in tight filum terminale. The spinal cord tension was relieved after surgery as shown by preoperative MRI. Recovery was mostly seen in infants and only in one older child. There is very little out there on tethered cord in adults. [13] The growth of body weight and the use of hormones may cause the increase of lipoma and increased symptoms of TCS. Of 40 cases without occupying lesions of tethered spinal cord, the symptoms were improved in 14 cases. 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. Kokubun S, Ozawa H, Aizawa T, Ly N M, Tanaka Y. Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. 2007 Mar;6(3):210-5. doi: 10.3171/spi.2007.6.3.210. At your childs first pediatric neurosurgical appointment, you can expect discussions with the care team about whether surgery is appropriate for your child and whether they need different imaging tests done. A lumbar laminectomy for release of a tethered cord. August 2017. 12 The causes of tethering, preoperative duration of symptoms, and completeness of untethering could cause the outcomes to vary. Second, a standardized surgical protocol was not used, and the surgical approach was left to the discretion of the attending surgeon. The severity of the condition and the associated signs and symptoms vary from person to person. The clinical records were reviewed for preoperative symptoms, duration of symptoms, complications, and neurologic improvements. It is important for patients to discuss the goal of surgery with their doctor. Liu JJ, Guan Z, Gao Z, et al. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. Search for condition information or for a specific treatment program. However, untethering carries risks of spinal cord injury and re-tethering. 9 Theodore N, Cottrill E, Kalb S, Zygourakis C, Jiang B, Pennington Z, Lubelski D, Westbroek EM, Ahmed AK, Ehresman J, Sciubba DM, Witham TF, Turner JD, Groves M, Kakarla UK. The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Unauthorized use of these marks is strictly prohibited. 13 On the other hand, although massive intraoperative bleeding is a problem, the percentage of cases in which complications have developed has been low with SSO (Table 5). Medicine. The care team uses neurophysiologic intraoperative monitoring during the entire surgery to ensure your childs spinal cord still works properly. The summary of outcomes from previous reports (Table 4) shows that the improvement of symptoms after surgery was more frequently observed with SSO. Management of adult tethered cord syndrome: our experience and review of literature. The laminae and transverse processes of the vertebrae at T12 and L2 were resected, and the pedicle screws were placed bilaterally at these vertebrae. official website and that any information you provide is encrypted Untethering surgery was performed as a first procedure at our institution, and a massive arachnoidal scar and adhesion were found intraoperatively. 5 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. Dermoid cyst and epidermoid cyst caused TCS was observed in 32 cases, with 6 cases indicating improved symptoms, 26 cases showing stabilized symptoms, and no case got worse. [Intramedullary mature teratoma associated with an attached cord and an intradural lipoma. WebThe dysfunction of nervous system in Cases 1, 2, and 4 disappeared within 3 weeks. eCollection 2020 Mar. Tethered Cord: Post-Operative Care 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. The preoperative pathology was lipomeningocele in all SSO group and lipoma or tight terminal filum in the untethering group. 6 In some children who have tethered cord syndrome, they may lose control of their bladder or bowels. Stretching and tension, especially in a growing child, can cause neurologic damage. In surgically treated patients, pain relief can often be achieved, and long-term neurological stabilization tends to persist more often than it does in conservatively treated patients. Although untethering surgery has been a standard treatment in patients with adult tethered cord syndrome (TCS), spine-shortening osteotomy (SSO) has recently been performed as an alternative technique. Medicine (Baltimore). A total of 72 cases applied positive straight incision, 10 cases of lumbosacral lipoma with longitudinal incision. Primary is typically a form of OSD while secondary usually occurs following a myelomeningocele repair or other type of spinal cord surgery History and Exam Tethered spinal cord is most commonly diagnosed in infancy by the discovery of a abnormality noticed on the skin of the back. 5 Garceau theorized that tension on the . 2nd ed. After surgery, all patients were followed up for an average of 2.5 years. Results: The https:// ensures that you are connecting to the 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. You or your child can typically resume usual activities within a few weeks after surgery.
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