Safe Care CommitmentGet the latest news on COVID-19, the vaccine and care at Mass General.Learn more. Adult tethered cord syndrome. 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. The https:// ensures that you are connecting to the Spinal column shortening is an indirect detethering surgery which shortens and fuses the spine to relieve longitudinal pressure on the spinal cord. Federal government websites often end in .gov or .mil. flag football tournaments 2022 tethered spinal cord surgery recovery time. 214-456-2444. Keyword Highlighting (C) Postoperative lateral radiograph 3 years after surgery shows complete bone union and significant spine shortening. 9 Two months later (a couple of weeks after her 10th birthday) on christmas break, she had surgery for the tethered cord (done by a neurosurgeon). 10 Pain or anti-inflammatory medication. It is not possible to predict whether your childs current symptoms will reverse. A T12 to L1 diskectomy and L1 upper one-third vertebral body resection were performed thereafter. 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). J Neurosurg Spine. Request an appointment or second opinion, refer a patient, find a doctor or view test results with MGfC's secure online services. Please enable scripts and reload this page. sharing sensitive information, make sure youre on a federal When surgeons operate around the spinal cord, the area where the CSF lies is opened so they can untether the spinal cord. Tremors or spasms in the leg muscles. 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. 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. In adults, dethetering of the spinal cord . Tethered cord syndrome: an updated review. 7 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. 2 Because neurological deficits are generally irreversible, early surgery is recommended. Next, the T12 and L2 vertebrae were compressed gradually by using a pedicle screwrod construct with somatosensory-evoked potentials and motor-evoked potentials monitoring. 8 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. In some instances, what is thought to be adult tethered cord syndrome is actually a similar abnormality affecting the spine. We offer diagnostic and treatment options for common and complex medical conditions. Your child will be encouraged to urinate on their own. The mean duration of follow-up was 4.73.5 years (range, 2.0 to 15.5 years). In adults, symptoms of tethered cord usually develop slowly. Independent sample t tests and Fisher exact tests were performed to compare the results between the untethering and SSO groups. Cui ZG, Xiu B, Xiao K, et al. In adults, surgery to free (detether) the spinal cord can reduce the size and further development of cysts in the cord. WebRecurrent tethered cord syndrome (TCS) can lead to significant progressive disability in adults. Surgical management of tethered spinal cord in adults: report of 54 cases. His preoperative symptoms were muscle weakness, gait disturbance, urinary and fecal dysfunction, and back and leg pain. FOIA Get the latest news, explore events and connect with Mass General. Improvement in clinical features was compared in the untethering and SSO groups (Table 3). An umbilical hernia repair is a relatively routine surgery and takes about 20 to 30 minutes. Tethered cord syndrome (TCS) is a neurologic disorder caused by abnormal traction of the spinal cord resulting from several pathologic conditions: thickened filum terminale, meningocele, lipomyelomeningocele, and split cord malformation.1 7 However, his condition subsequently deteriorated, and he could not walk by himself 1year after untethering surgery. Highlight selected keywords in the article text. government site. A total of 32 consecutive adult patients underwent untethering surgery for secondary tethered cord syndrome in our department from January 2008 until December 2018. Funding/support: This study was supported by Peking Union Medical College Youth Research Funds (2016) (project no. Management of adult tethered cord syndrome: our experience and review of literature. 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, Wang XG, Zhou YD, Ji SJ, et al. 6. A conservative approach is warranted, however, in adult patients without neurological deficits. Short-term results were determined within 3 months of surgery, whereas long-term outcomes (clinical recurrences) were evaluated using Kaplan-Meier statistics. You may search for similar articles that contain these same keywords or you may to analyze our web traffic. Frequent micturition, diminished knee and ankle reflexes, and difficulty in bending were exhibited in partial patients. Careers. Get the latest news on COVID-19, the vaccine and care at Mass General. [4] In 1953, Garceau described the filum terminal syndrome, suspected that the tensive filum terminal pulled the spinal cord might cause defecation dysfunction and other symptoms. Untethering surgery was performed in 11 patients, and SSO was performed in three patients as initial surgeries for adult TCS in our institutions. Tethered cord means that the spinal cord movement is limited within the spinal column due to abnormal tissue attachments. 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. collected, please refer to our Privacy Policy. Learn about career opportunities, search for positions and apply for a job. Tethered Cord. Medicine (Baltimore). Definition. This causes extra stress on the nerves and can cause a range of symptoms known as tethered cord syndrome. Cerebrospinal fluid leakage and urinary infection occurred in 1 patient each among those with untethering, and massive intraoperative bleeding occurred in 1 patient with SSO. The operation curative effects for TCS with different symptoms. Through the long-term follow-up, patients with a shorter duration, lighter TCS degree, generally the prognosis would be good, and symptoms improved significantly; on the other hand, for patients with longer course of disease, serious TCS, and higher frequency that tumor wrapped around the cauda equina, corresponding surgery effect was not so obvious; some patients even showed no improvement of symptoms, and the risk of postoperative TCS was relatively high. Postoperative bony fusion was confirmed in all patients with SSO by analysis of computed tomography reconstruction images at 1year after surgery. The effect of tethered cord release on coronal spinal balance in tight filum terminale. [2], In 1886, Von Reeklinghausen reported autopsy results of the patients with lumbosacral hypertrichosis accompanied with spina bifida, showing that the spinal cord was adhered to fat in the lumbosacral region, conus terminalis was indicated to be tensed. 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. This way, the care team can best assess your childs condition at their first appointment. 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. 11/2021. The preoperative pathology was lipomeningocele in all SSO group and lipoma or tight terminal filum in the untethering group. 13 Therefore, untethering surgery is not always a promising procedure.11. 15. Untethering (tethered cord release) is the gold standard treatment for TCS. However, to use this type of procedure for spinal cord tethering is new and extremely rare, says Theodore . 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. . 20. In patients demonstrating Neurosurg Focus. All the 82 cases of patients received nerve electrophysiology monitoring assisted microsurgery. The surgical scheduler will work with you and family to coordinate a surgical date that fits best into your and your childs schedules. Surgery is lengthier in adults since they have thicker backs than children do. A hairy patch overlying the spine in any area is almost always associated with an underlying splitting of the spinal cord by a band of fibrous tissue or bone (a diastematomyelia). Their clinical charts, operative records, and follow-up data were reviewed. The average length of spine shortening was 23.3 mm. Fatty Filum Terminale. Thus, additional prospective randomized large-scale studies are needed to confirm our results. He or she can have a pillow but do not raise the head of the bed. The variations of tethering lesions were tight terminal filum (present in 1 patient), lipoma (5 patients), and lipomyelomeningocele (8 patients). To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). Recovery from the surgery is one to two weeks of . WebA tethered spinal cord occurs when the spinal cord is attached to tissue around the spine, most commonly at the base of the spine. Horrion J, Houbart MA, Georgiopoulos A, et al. 4 For larger cysts, it is not possible to force the free capsule wall directly, because the cone and the cauda equina are in a high tension state, and any tiny stretching is likely to cause further damage. 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. Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work. (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. 18. It is important for patients to discuss the goal of surgery with their doctor. These guidelines often differ depending on surgical procedure. Perioperative complications are another concern in adult TCS. In children, the surgery to de-tether the spinal cord is more common and can be done at many institutions; the procedure is also lower risk in children than in adults. The patients' backgrounds in the two groups are summarized in Table 2. Results: If they do experience a headache, your child will lay back down flat. 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. MeSH Other clinical features at presentation included foot deformity in 9 patients (64%) and scoliosis in 4 patients (29%). In this study, we evaluated the feasibility of BCR monitoring during untethering surgery in infants and children to predict postoperative urinary and bowel dysfunction. WebWhat happens after tethered spinal cord surgery? Prompt surgical treatment is often necessary to avoid permanent sequelae. You will have many questions about the disorder, and we are here to answer them. WebIn adults, symptoms are aggravated by trauma, maneuvers associated with stretching of the spine (flexion), disc herniation, and spinal stenosis. 11 6 A representative case of spine-shortening osteotomy. The most common symptoms of tethered cord, such as back pain, abnormal gait and urinary accidents are frequently attributed to other causes during childhood. A tethered cord release reduces or removes the . Neurol Sci. This prevents the spinal cord from moving to keep up with the lengthening of the spine as it grows. 2. 2018 Mar;97(11):e0111. Besides, there was no deteriorated case. 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]. Among individuals who did not undergo surgery, 17 patients refused surgery and 25 patients underwent recommended conservative treatment. Yamada S, Won D J, Pezeshkpour G. et al. Anesthesia, Critical Care & Pain Medicine, Billing, Insurance & Financial Assistance, Unusual dimple or bump near the lower part of the spine. 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. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. Based on this small retrospective case series, SSO appears to provide clinical improvement at least comparable to the untethering procedure, especially in more challenging cases. The authors reviewed their experience of newly diagnosed adult TCS patients to identify and explore TCS misdiagnosis, recognition, subtype pathology . Syringomyelia is a disorder in which a fluid-filled cyst (called a syrinx) forms within the spinal cord. Miyakoshi N, Abe E, Suzuki T, Kido T, Chiba M, Shimada Y. Spine-shortening vertebral osteotomy for tethered cord syndrome: report of three cases. Phi J H, Lee D Y, Jahng T A, Chung C K, Kim H J. Tethered cord syndrome in adulthood: reconsidering the prognosis. The most common treatment for tethered spinal cord is a lumbar laminectomy to release the tethered cord.