Tethered cord syndrome in adulthood

Abstract

Objective/background: The standard treatment for tethered cord syndrome (operative vs nonoperative management) that presents in adulthood remains controversial. A comparative study of tethered cord syndrome in adulthood is needed.

Design: A retrospective chart-based analysis.

Methods: Patients admitted to Gulhane Military Medical Academy Department of Neurosurgery for management of caudal spinal cord tethering from June 1999 through December 2006 (N = 22).

Results: Conus level was normal in 1 patient with split cord malformation and dermal sinus. Tight terminal filum was found in 21 patients, including postrepair myelomeningocele tethered cord in 4, lipomyelomeningocele/meningocele in 8, split cord malformation in 3, dermal sinus in 7, and syringomyelia in 3. The most common complaints were back pain (15 patients, 68.1%), bladder dysfunction (8, 36.3%), fecal incontinence (2, 9.09%), and leg pain (7, 31.8%). One patient had hydrocephalus (4.5%). Ten of 22 patients underwent surgery; 8 of 10 patients had detethering; and 12 patients refused surgery. Postoperative cerebrospinal fluid leakage requiring reinforcement sutures occurred in 1 patient. There were no infectious complications. Neurologic status and outcomes were compared with preoperative findings.

Conclusions: Some patients refuse surgery despite severe neurologic disturbances. Neurosurgeons should fully explain the risks and benefits of surgery for tethered cord to the patient and family. A much larger and prospective randomized series is needed to determine the effects of operative vs nonoperative management of tethered cord syndrome in adulthood.

Figure 1. Patient with tethered cord syndrome and lipomyelomeningocele (case 8) who declined detethering. (a) T1-weighted image of sagittal lumbar magnetic resonance imaging. (b) T1-weighted image of axial lumbar magnetic resonance imaging at the level of lipomyelomeningocele.

Figure 2. Patient with tethered cord syndrome, meningocele, agenesis of corpus callosum, cutaneous stigmata (hypertrichosis), altered sensation, and leg length discrepancy who refused surgery (case 10). (a) T2-weighted sagittal magnetic resonance imaging of lumbar region. (b) T1-weighted image of sagittal cranial magnetic resonance imaging.

Figure 3. Patient with tethered cord, split cord malformation at L1 level, dermal sinus, and meningocele (case 11), who declined detethering. (a) Proton density-weighted image of sagittal lumbar magnetic resonance imaging. (b) T2-weighted image of axial lumbar magnetic resonance imaging at the level of split cord malformation.