Shinjo T, Hayashi H, Takatani T, Boku E, Nakase H, Kawaguchi M. J Clin Monit Comput. The site is secure. 7 For all patients, pain was the most common major complaint. Keyword Highlighting There were no significant differences in age, sex, types of preoperative symptoms, or duration of follow-up between the two groups. 2011 Jun 15;36(14):E944-9. A T12 to L1 diskectomy and L1 upper one-third vertebral body resection were performed thereafter. In adults, symptoms of tethered cord usually develop slowly. Equipment. Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis. Surgeries were performed under continuous electrophysiologic neuromonitoring with somatosensory-evoked potentials, combined with motor-evoked potentials, and electromyography with direct nerve root stimulation. A. 7 11 neurologic recovery with regard to pain and 10 The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies. Surgical effects were evaluated by observing improvement of symptoms of each patient postoperatively. Neurosurgeons have long performed procedures that inadvertently shorten the spinal column, such as partially or fully removing vertebrae when a cancerous tumor arises within the bone. 11 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. Others could end up re-tethered within months of the first surgery. HHS Vulnerability Disclosure, Help 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. Besides, there was no case of infection, new onset of nerve injury or second TCS postoperatively. Patients who underwent surgery for TCS secondary to posttraumatic or postinflammatory conditions were not included in this study. Hertzler DA 2nd, DePowell JJ, Stevenson CB, et al. Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. 2016 Sep;6(6):535-41. doi: 10.1055/s-0035-1569004. PMC Other clinical features at presentation included foot deformity in 9 patients (64%) and scoliosis in 4 patients (29%). Improvement in clinical features was compared in the untethering and SSO groups (Table 3). The most common treatment for tethered spinal cord is a lumbar laminectomy to release the tethered cord. Liu JJ, Guan Z, Gao Z, et al. 1). Independent sample t tests and Fisher exact tests were performed to compare the results between the untethering and SSO groups. 2020 Feb;41(2):249-256. doi: 10.1007/s10072-019-04056-2. Stetler WR Jr, Park P, Sullivan S. Pathophysiology of adult tethered cord syndrome: review of the literature. All patients underwent surgery. It is not a substitute for medical advice and should not be used to treatment of any medical conditions. J Neurosurg. However, Untethering surgery was performed in 11 patients, and SSO was performed in three patients as initial surgeries for adult TCS in our institutions. 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. 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. Tethered cord syndrome in adults: experience of 56 patients. The surgical scheduler will work with you and family to coordinate a surgical date that fits best into your and your childs schedules. During this call, the nurse will help decide which type of anesthesia is best for your child and if your child may have any risks with anesthesia. 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 Long-term results showed a good prognosis in patients in whom first-time (that is, nonrevision) surgery achieved successful untethering, with a 10-year rate of neurological stabilization in 89% of Group A and a 10-year rate of neurological stabilization in 81% of Group B patients. 1B). 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. The mean age of the patients was 46 13 years (range 23-74 . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Results: A tethered spinal cord occurs when the inelastic tissue on the caudal spinal cord is abnormally attached to a structure instead of free floating. The operation curative effects with curative rates for TCS with different symptoms, and signs are shown in Table 2 in detail. Fax: 214-456-2497. Please try after some time. WebIn adults, symptoms of tethered cord often develop slowly, but they can become quite severe. Accessibility Tethered cord syndrome: a review of the literature from embryology to adult presentation. In the article, Surgical treatments on adult tethered cord syndrome: A retrospective study, which appeared in Volume 95, Issue 46 of Medicine, a sentence in the abstract, A retrospective analysis of 82 adult patients (17 male cases, 82% and 24 female cases, 59%) appeared incorrectly and should have appeared as A retrospective analysis of 82 adult patients (34 male cases, 41.5% and 48 female cases, 58.5%) In , the totals in the Complete release and Partial release columns appeared incorrectly and should have appeared as seen in the table below. Tethered Cord Syndrome in Children and Adults. 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. Mitsuhiro Kamiya, none All the patients were from China and of Asian ethnicity. A post-traumatic tethered cord can occur . Kenyu Ito, none For this procedure, the patient is placed under general anesthesia. Treatment of posttraumatic syringomyelia. [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. This study has two limitations in particular. This can lead to infection if the incision is on the low back. Pain or anti-inflammatory medication. Statistical analyses were performed using SPSS version 18 (SPSS Inc., Chicago, Illinois, United States). Duraplasty using substitute materials was performed at the close of surgery. This causes extra stress on the nerves and can cause a range of symptoms known as tethered cord syndrome. Some error has occurred while processing your request. WebIntroduction. Severe neurological deficits were rare. . Tethered cord syndrome in childhood: special emphasis on the surgical technique and review of the literature with our experience. Because neurological deficits are generally irreversible, early surgery is recommended. to maintaining your privacy and will not share your personal information without 6 The benefit of secondary operations in Group B was limited, with eventual clinical deterioration occurring in all patients within 10 years. Correspondence: Yongning Li, Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. Results. Iskandar BJ, Fulmer BB, Hadley MN, Oakes WJ. Features of the condition may include foot and spinal abnormalities; weakness in the legs; loss of sensation (feeling) in the lower limbs; lower back pain; scoliosis; and urinary incontinence. A conservative approach is warranted, however, in adult patients without neurological deficits. Controversy persists regarding surgery in asymptomatic adults with TCS. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by/4.0, Surgical treatments on adult tethered cord syndrome: A retrospective study, Articles in Google Scholar by Jun Gao, MD, PhD, Other articles in this journal by Jun Gao, MD, PhD, The efficacy and safety of pre-emptive methoxamine infusion in preventing hypotension by in elderly patients receiving spinal anesthesia: A PRISMA-compliant protocol for systematic review and meta-analysis, Minimally invasive pedicle screw fixation, including the fractured vertebra, combined with percutaneous vertebroplasty for treatment of acute thoracolumbar osteoporotic compression fracture in middle-age and elderly individuals: A prospective clinical study, Three dimensional finite element analysis used to study the influence of the stress and strain of the operative and adjacent segments through different foraminnoplasty technique in the PELD: Study protocol clinical trial (SPIRIT Compliant), Risk Factors for Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis, Privacy Policy (Updated December 15, 2022). 1994 Oct;81(4):513-9. doi: 10.3171/jns.1994.81.4.0513. 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. Comparative Study of Untethering and Spine-Shortening Surgery for Tethered Cord Syndrome in Adults. 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. Neurosurg Focus. Of 32 cases with tethered spinal cord caused by dermoid cyst and epidermoid cyst, the symptoms were improved in 6 cases. Before 4 In this group of patients, postoperative pain symptoms of lumbosacral portion and both lower extremities improved significantly and remarkably, the defecation dysfunction in most patients was improved to some extent, but there were still some patients having frequent micturition and urinary retention; furthermore, muscle strength of lower limbs also increased, most patients had different degrees of improvement of muscle strength, which was basic consistent with the conclusion draw from Htittmann. Adult tethered cord syndrome. Of the 2515 patients, 85 adults with a tethered cord syndrome formed the basis of this study. The average length of spine shortening was 23.3 mm. His preoperative symptoms were muscle weakness, gait disturbance, urinary and fecal dysfunction, and back and leg pain. The child usually can resume normal activities within a few weeks. You may be trying to access this site from a secured browser on the server. For patients treated conservatively, follow-up information could be obtained in 33 of 42 patients. Long-term surgical results and patient outcome ratings were encouraging. Koji Sato, none The nurse will help schedule the COVID-19 PCR test. The filum terminale syndrome (the cord-traction syndrome). doi: 10.3171/FOC-07/08/E2. Surg Neurol. A total of 32 consecutive adult patients underwent untethering surgery for secondary tethered cord syndrome in our department from January 2008 until December 2018. But previous investigation estimated that no more than 40% of dermoid cyst could be completely removed. WebFollowing a tethered cord release surgery, children are typically discharged in 1-2 days after surgery. Following a tethered cord release surgery, children are typically discharged in 1-2 days after surgery. All the 82 cases of patients received nerve electrophysiology monitoring assisted microsurgery. In addition and preoperatively, there were 68 cases (83%) of varying degrees of pain in the lumbosacral portion and lower extremity, 58 cases (71%) of motor dysfunction of the lower extremity, 44 cases (54%) with abnormal sensation, and 50 cases (61%) of defecation dysfunction.
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