The end of the spinal cord normally hangs and moves freely inside the spinal column. 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. 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. This site needs JavaScript to work properly. 3 [11] In this paper, we suggest that it is possible to cut off the filum terminale if there will have no injury to the nerve under electrophysiological monitoring, corresponding prognostic outcome will be better than that that without disconnection of filum terminale. 8 Accessibility Epub 2019 Oct 9. Accessibility Tethered cord syndrome (TCS) refers to a series of neurological dysfunction caused by the retraction of the conus medullaris related to a variety of reasons, which is manifested by both lower extremities orbicularis weakness, sensory abnormalities, defecation dysfunction, and so on.[1]. Duraplasty using substitute materials was performed at the close of surgery. The effect of tethered cord release on coronal spinal balance in tight filum terminale. Because neurological deficits are generally irreversible, early surgery is recommended. The mean age at onset of symptoms and diagnosis was 30 years and 37 years, respectively. 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. A syringo-subarachnoid shunt to drain the cyst. Next, the T12 and L2 vertebrae were compressed gradually by using a pedicle screwrod construct with somatosensory-evoked potentials and motor-evoked potentials monitoring. 13 Therefore, untethering surgery is not always a promising procedure.11. 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. 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. As a result, the spinal cord can't move freely within the spinal canal. Log in | Become a member | Create an Account If you are unable to log in contact membership@cns.org In this study, we evaluated the feasibility of BCR monitoring during untethering surgery in infants and children to predict postoperative urinary and bowel dysfunction. 7 Intraoperative feasibility of bulbocavernosus reflex monitoring during untethering surgery in infants and children. The patient with symptoms following resection of a lipomyelomeningocele: do increases in the lumbosacral angle indicate a tethered spinal cord? Hoffman HJ, Hendrick EB, Humphreys RP. 9 In the current study, despite longer duration of symptoms, higher rate of prior surgery, and complex preoperative categories of tethering lesions with SSO, the clinical outcome was better with SSO. 2 2. 12 OBJECTIVE Tethered cord syndrome (TCS) has been well described in pediatric patients. By preoperative Hoffman grading, in the 20 cases with grade 1, 8 cases of patients indicated symptoms improvement to grade 0; in cases with grade 2, 6 cases of patients were improved and transferred to grade 1, and 2 cases of patients transferred into grade 0; in cases with grade 3, 4 cases of patients showed improved symptoms and changed into grade 2; in cases with grade 4, 2 cases were improved and changed into grade 3. Symptoms of Tethered Spinal Cord Syndrome in Teens and Adults. Bethesda, MD 20894, Web Policies Equipment. A conservative approach is warranted, however, in adult patients without neurological deficits. Spina Bifida: Pathogenesis, Mechanisms, and Genes in Mice and Humans. Yamada S, Lonser RR. The average length of spine shortening was 23.3 mm. Bethesda, MD 20894, Web Policies Tethered cord release surgery is a type of surgery to reduce or remove the tissue that is preventing the spinal cord from moving freely. Some error has occurred while processing your request. 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 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. He or she can have a pillow but do not raise the head of the bed. During the first 24 hours, your child will remain flat on their back to prevent fluid leak from the incision. 11 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. Diagnosis: Adult tethered cord is Klekamp J. Tethered cord syndrome in adults. The overall clinical improvement was significantly greater in the SSO group (90.0%) than in the untethering group (33.3%; p=0.003). His motor weakness marginally improved after SSO; however, he did not improve sufficiently to be able to walk by himself. Object: Tethered cord occurs when the spinal cord is attached to tissues around the spine, most commonly at the base of the spine. Clipboard, Search History, and several other advanced features are temporarily unavailable. Tethered cord, also called tethered spinal cord syndrome, occurs when the spinal cord abnormally attaches to tissue inside the spinal canal, usually at the base of the spine. 13. Fioricet was the first migraine medication I was prescribed. The management of tethered spinal cord syndrome with onset of symptomatology occurring in adulthood remains controversial, although the necessity of early surgery in the pediatric tethered cord syndrome population is well established. A. The surgical scheduler will work with you and family to coordinate a surgical date that fits best into your and your childs schedules. dispersed camping roosevelt national forest, approach to pancytopenia in pediatrics ppt, cedar ridge high school basketball roster, private landlords in garfield heights ohio, que pasa cuando los dos amantes son casados, margot robbie samara weaving and jaime pressly, how to broadcast party chat on twitch xbox one, illinois state law on medication administration, purpose of short service line in badminton. One patient in the untethering surgery group underwent SSO because the symptoms worsened 1year after untethering. 15. After identification of the terminal filum, we confirmed electromyography activity on bipolar stimulation before clip ligation and definitive sectioning. Adult tethered cord is rare. The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review. bDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA. Statistical analyses were performed using SPSS version 18 (SPSS Inc., Chicago, Illinois, United States). In Group A, 20 of 43 patients underwent surgery, whereas in Group B 23 of 42 patients underwent surgery. WebThe clinical recurrence rate in all conservatively treated patients was 21% after 10 years. 13 general health condition is usually good, so SSO could be an appropriate procedure for adults with TCS. The care team will review your childs symptoms and how tethered cord syndrome is affecting their quality of life. As an alternative to untethering surgery, Kokubun et al have performed SSO since 1995 in patients with TCS caused by a lipomyelomeningocele because osteotomy is believed to reduce the tension in the spinal cord.10 FOLLOW ME ON INSTAGRAM-https://www.instagram.com/mattandemmHello, my name is Emily and I'm here to give you a peek into my daily life. This can cause the spinal cord to stretch out as the spine grows, leading to possible nerve damage, pain and other symptoms. Tethered cord, also called tethered spinal cord syndrome, occurs when the spinal cord has abnormal attachments inside the spinal canal, usually at the base of the spine. In adults, surgery to free (detether) the spinal cord can reduce the size and further development of cysts in the cord. Romagna A, Suchorska B, Schwartz C, Tonn J C, Zausinger S. Detethering of a congenital tethered cord in adult patients: an outcome analysis. 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. After exposing the dura mater spinalis, it was cut from the normal anatomical structure to the lesion. As a result, the spinal cord cant move freely 9 HHS Vulnerability Disclosure, Help He presented with symptoms of lower back pain and legs pain. We report a 63-year-old man with sudden-onset severe right chest and upper back pain, followed by . 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 . It is not possible to predict whether your childs current symptoms will reverse. doi: 10.1097/BRS.0b013e3181fc2edd. Shinjo T, Hayashi H, Takatani T, Boku E, Nakase H, Kawaguchi M. J Clin Monit Comput. The .gov means its official. 9 Rev. Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients. So for you to be re-tethered isn't because there may have been a misstake made during the first surgery, but because your body produced more scarring that caused the cord to reattach itself. WebHave you lie flat on your back for up to 72 hours to prevent cerebrospinal fluid from leaking around the spinal cord During your stay, the hospital staff will take steps to lower your The child usually can resume normal activities within a few weeks. 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. In the patients who had undergone myelomeningocele repair during infancy or previous untethering surgery, meticulous dissection was required to ensure complete release of the spinal cord because of extensive arachnoidal adhesions. Epub 2012 Jul 13. After surgery, all patients were followed up for an average of 2.5 years. Please try again soon. (A) Preoperative lateral radiograph. [10] Of course, if the relief of tethered parts of the cauda equina obtained a relatively satisfactory outcome during the surgery, most occupying lesions and diseased filum terminale were removed, postoperative symptoms improved at different degrees, further recovery of the nerve function could thus be observed in the long-term follow-up period. WebConclusions: Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. Request an appointment or second opinion, refer a patient, find a doctor or view test results with MGfC's secure online services. 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. Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis. A post-traumatic tethered cord can occur . 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. The site is secure. 5 [5] In 1976, Hoffman et al[6] reported 31 patients combined with conus medullaris after stretching slenderization, corresponding nerve function were improved following cutting off the tensive and thicker and filum terminale; besides, syndrome that the conus medullaris was stretched was named tethered spinal cord syndrome, has been used to describe for nervous dysfunction caused by conus medullaris stretching. Lumbosacral laminectomies were performed to obtain adequate exposure of the conus medullaris and cauda equina. Iskandar BJ, Fulmer BB, Hadley MN, Oakes WJ. I am just your average. Back and leg pain improved in 50 and 63% of patients, respectively. Quiones-Hinojosa A, Gadkary CA, Gulati M, von Koch CS, Lyon R, Weinstein PR, Yingling CD. Patient age ranged from 19 to 75 years. 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 severity of the condition and the associated signs and symptoms vary from person to person. Would you like email updates of new search results? The preoperative duration of symptoms was significantly longer (2512.4 years) and the percentage of those with prior surgery was higher in the SSO group (66.7%). 9. 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. 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 . The mean age of the patients was 46 13 years (range 23-74 years) and the mean follow-up duration was 61 62 months. and transmitted securely. With a recommendation for surgery this figure rose to 47% within 5 years. Chapman P H. Congenital intraspinal lipomas: anatomic considerations and surgical treatment. In some instances, what is thought to be adult tethered cord syndrome is actually a similar abnormality affecting the spine. He underwent SSO 1.5 years after untethering surgery. 2022 Oct 6;10(28):10375-10383. doi: 10.12998/wjcc.v10.i28.10375. It is recommended that routine examination of filum terminale should be performed in the operation, associated with the disconnection of the diseased filum terminale subject to adhesion or thickening and shortening. Your child may need an operation to help the spinal cord move freely. to analyze our web traffic. Get the latest news, explore events and connect with Mass General. Untethering surgery was performed in 11 patients, and SSO was performed in three patients as initial surgeries for adult TCS in our institutions. But in Case 3, the paraesthesia and weakness of lower extremities were persistent, and there Object: Although postsurgical neurological outcomes in patients with tethered cord syndrome (TCS) are well known, the rate and development of neurological improvement after first-time tethered cord release is incompletely understood. Let us help you navigate your in-person or virtual visit to Mass General. Your child will also need a COVID-19 PCR test 48 hours (2 days) before surgery. In contrast, fusion surgery in SSO might lead to adjacent segment disease that may require subsequent surgery in the long term after SSO. This means a shorter, Walk on their own (if appropriate for age), Diazepam (Valium) to prevent muscle spasms. Yukihiro Matsuyama, none J Neurosurg Spine. Others could end up re-tethered within months of the first surgery. Neurol Sci. Bulbocavernosus reflex (BCR) monitoring is used to assess the integrity of urinary and bowel function. The .gov means its official. 10 WebA 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. Doctor en Historia Econmica por la Universidad de Barcelona y Economista por la Universidad de la Repblica (Uruguay). The laminae and transverse processes of the vertebrae at T12 and L2 were resected, and the pedicle screws were placed bilaterally at these vertebrae. There is very little out there on tethered cord in adults. Controversy persists regarding surgery in asymptomatic adults with TCS. Bookshelf 2011 Jun 15;36(14):E944-9. may email you for journal alerts and information, but is committed Improvement in clinical features was compared in the untethering and SSO groups (Table 3). Kenyu Ito, none WebRecovery from the surgery is one to two weeks of very limited activity to ensure proper healing of the surgical site and to prevent leaking of any cerebrospinal fluid. To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). Management of adult tethered cord syndrome: our experience and review of literature. 1B). Review of the literature]. 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 https:// ensures that you are connecting to the 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. The care team is well educated in providing pain management options based on the Enhanced Recovery After Surgery (ERAS) protocol. 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. A T12 to L1 diskectomy and L1 upper one-third vertebral body resection were performed thereafter. When possible, the care team can plan surgery close to school vacations. 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. (D) Postoperative sagittal T2-weighted MRI scan obtained 1year after surgery. Tethered cord syndrome: an updated review. World J Clin Cases. 6 9 As the child grows taller, the spinal cord is stretched. Highlight selected keywords in the article text. The care team uses neurophysiologic intraoperative monitoring during the entire surgery to ensure your childs spinal cord still works properly. 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. A potential predictor of long-term bladder function after detethering surgery in patients with tethered cord syndrome. A representative case of spine-shortening osteotomy. stretching. Tethered cord results when the spinal cord cannot normally ascend with growth, which . TCS in adults is relatively rare and includes a wide spectrum of pathologies.1 Van Leeuwen et al established four subgroups based on their original tethering pathologies and reported the clinical outcomes after untethering surgery: (1) postrepair myelomeningocele; (2) terminal filum lipoma and tight terminal filum; (3) lipomyelomeningocele and conus lipoma; (4) split cord malformation.5 These etiologic backgrounds were found to affect the clinical outcome after untethering. Short-term postoperative results indicated a significant improvement of pain and a stabilization of neurological symptoms. The authors reviewed their institutional experience with the surgical management of adult TCS to assess the time course of symptomatic improvement, and to . Unauthorized use of these marks is strictly prohibited. Recovery was mostly seen in infants and only in one older child. I had tethered cord release and had micro leaks for 7 months with 3 blood patches at different levels. Tethered cord means the spinal cord cannot move inside the spinal column. Abbreviation: TCS = tethered cord syndrome. and transmitted securely. Surgical experience of 120 patients with lumbosacral lipomas. This lessens the chance of any major complications caused by damage to the spinal cord. government site. Six hospitals in our spine group were included. Pathology and treatment of tethered cord syndrome with lipoma. Other clinical features at presentation included foot deformity in 9 patients (64%) and scoliosis in 4 patients (29%). Tokumi Kanemura, none Imaging is very important for the diagnosis of tethered cord. However, some neurological and motor impairments may not be fully correctable. 7. Adult Tethered Cord is characterized by a spinal cord that is located at an abnormally low position within the spinal canal. The preoperative pathology was lipomeningocele in all SSO group and lipoma or tight terminal filum in the untethering group. Throughout the entire surgery, the care team will check how your childs spinal cord is working properly. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, People's Republic of China (e-mail: [emailprotected]). Patients who underwent surgery for TCS secondary to posttraumatic or postinflammatory conditions were not included in this study. Surgical options include: Suboccipital decompression for Chiari malformation. Medicine. WebThe dysfunction of nervous system in Cases 1, 2, and 4 disappeared within 3 weeks. Adult tethered cord syndrome. At Mass General, the brightest minds in medicine collaborate on behalf of our patients to bridge innovation science with state-of-the-art clinical medicine. Complications include infection, bleeding, and damage to the spinal cord or myelomeningocele, which may result in decreased muscle strength or bladder or bowel function. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. Epub 2015 Nov 26. Throughout her time in high school, she had frequent . The patient was a 36-year-old man who had undergone myelomeningocele repair during infancy. Number of patients with organ space infection within 30 days of principal operative procedure Readmission within 30 days Return to the OR within 30 days Educational Module Download Tethered Cord: Post-Operative Care Educational Module Updated February 12, 2021 Key References: Bowman RM, Mohan A, Ito J, Seibly JM, 4 This causes extra stress on the nerves and can cause a range of symptoms known as tethered cord syndrome. 11 Wang XG, Zhou YD, Ji SJ, et al. 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. This site needs JavaScript to work properly. WebSpray Foam Equipment and Chemicals. For all patients, pain was the most common major complaint. Tight terminal filum is easy to manage and has excellent outcome, but the complexity of the other pathologies makes it difficult to achieve sufficient clinical results in those cases.7 Some patients may be misdiagnosed as having sciatica, a more common source of lower back . Frequent micturition, diminished knee and ankle reflexes, and difficulty in bending were exhibited in partial patients. Physical therapy. Preoperative motor deficits improved in 67% of the patients. Surgery in adult patients with a tethered cord syndrome should be reserved for those with symptoms. Pathophysiology of tethered cord syndrome and similar complex disorders. Besides, there was no case of infection, new onset of nerve injury or second TCS postoperatively. The percentage of patients with prior surgery was higher in the SSO group than in the untethering group, although the difference was insignificant. [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 can lead to infection if the incision is on the low back. A total of 32 consecutive adult patients underwent untethering surgery for secondary tethered cord syndrome in our department from January 2008 until December 2018. 17. However, The authors reviewed their experience of newly diagnosed adult TCS patients to identify and explore TCS misdiagnosis, recognition, subtype pathology . sharing sensitive information, make sure youre on a federal Chern JJ, Dauser RC, Whitehead WE, Curry DJ, Luerssen TG, Jea A. Spine (Phila Pa 1976). Following a tethered cord release surgery, children are typically discharged in 1-2 days after surgery. PMC 2006 Jul;105(1 Suppl):62-4. doi: 10.3171/ped.2006.105.1.62. Values of p<0.05 were considered to indicate statistical significance. The records of 22 patients ranging from 4 days to 10 years old (mean 2.7 Webtom kenny rick and morty characters. 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. Surgical effects were evaluated by observing improvement of symptoms of each patient postoperatively. Recovery involves a period of immobility where the . FOIA sharing sensitive information, make sure youre on a federal Would you like email updates of new search results? Abstract. 16. Your childs urinary catheter will be removed. Scientifica (Cairo). Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work. Iskandar B J, Fulmer B B, Hadley M N, Oakes W J. Congenital tethered spinal cord syndrome in adults. Surgical complications were generally minor. Arai H, Sato K, Okuda O, et al. 19-42. . smoke city char bar los angeles; youth sports referee jobs; que pasa cuando los dos amantes son casados; margot robbie samara weaving and jaime pressly Correspondence: Yongning Li, Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. Object: Despite having symptoms from birth, I was only recently . Tethered cord syndrome in adults: experience of 56 patients. Surgery is lengthier in adults since they have thicker backs than children do. However, his condition subsequently deteriorated, and he could not walk by himself 1year after untethering surgery. Clinical improvement 1 year after surgery in our study showed back pain improvement in 60% of children and 75% of adults, parathesia improved in 60% of His preoperative symptoms were muscle weakness, gait disturbance, urinary and fecal dysfunction, and back and leg pain. All patients received a 0.5 to 3.5-year follow-up by outpatient or telephone, with an average follow-up period of 2.5 years. Bethesda, MD 20894, Web Policies This study compared clinical outcomes and perioperative complications resulting from untethering and SSO surgery performed on patients with adult TCS. Your child will be encouraged to urinate on their own. Altered sensation (numbness or paresthesia) and bladder and/or fecal dysfunction were the most common complaints among 11 patients (79%). Conclusions: For cyst wall with many serious adhesions of cauda equina nerve, partial resection of the cyst wall can be performed under electrophysiological monitoring, which will also have a good operation effect. A tethered cord may go undiagnosed until adulthood when sometimes complex and severe symptoms come on slowly over time. Unauthorized use of these marks is strictly prohibited. 9 7 We are committed to providing expert caresafely and effectively. My headaches began as intolerance to light and sound. [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. They are the result of incorrect "dysjunction" of the neuroectoderm with incomplete separation of the epidermis (overlying skin) from the neural tube (spinal cord and central nervous system) and . FOIA The treatment of tethered cord syndromes in adults is discussed regarding the natural history and surgical indications. MeSH terms Typically, there is also a short filum and, as a result of both anomalies, a tethered cord. [20] Therefore, early diagnosis and early surgical treatment will be possible to obtain a better prognosis for patients with symptomatic adult TCS. In patients demonstrating (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. 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. All patients underwent surgery. 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.
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