A Preliminary Report on the Use of Laser-Doppler Flowmetry during Tethered Spinal Cord Release

Schneider, Steven J.; Rosenthal, Alan D.; Greenberg, Burt M.; Danto, Joseph

doi:10.1227/00006123-199302000-00010

Cited by 53 publications

(17 citation statements)

References 15 publications

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“…10, 22 The surgery itself is an effective procedure associated with low morbidity and prevents longterm morbidity resulting from the natural progression of the disease process. 7,8 In adult TCS, the late onset of symptoms is attributed to repeated microtrauma during flexion and extension of a mechanically tethered spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Reversal of longstanding neurological deficits after a late release of tethered spinal cord

Gupta¹,

Heary²,

Michaels

2010

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The importance of early surgery for tethered cord syndrome in the pediatric population is well established. Optimal treatment and prognosis of tethered cord in adults, on the other hand, is less clear. Some advocate a conservative approach in asymptomatic patients, while others recommend early detethering in all patients. For symptomatic patients, however, there is a consensus in favor of early surgery to prevent progression of neurological deficit. Many studies have reported cessation of neurological decline or reversal of recently acquired neurological deficits in patients with adult tethered cord syndrome. There are limited data in the literature about late surgery for the treatment of tethered spinal cords when the neurological deficits are longstanding. We report on a 37-year-old woman who demonstrated dramatic neurological improvement after surgical release of a tethered spinal cord more than 20 years after the onset of progressive neurological deficits.

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Section: Discussionmentioning

confidence: 99%

Reversal of longstanding neurological deficits after a late release of tethered spinal cord

Gupta¹,

Heary²,

Michaels

2010

FOC

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“…Schneider et al 23 used laser Doppler flowmetry and identified a significant increase in the blood flow at the caudal spinal cord after untethering operations.…”

Section: 14mentioning

confidence: 99%

Spinal cord traction, vascular compromise, hypoxia, and metabolic derangements in the pathophysiology of tethered cord syndrome

Filippidis

Kalani²,

Theodore³

et al. 2010

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Object The definition of tethered cord syndrome (TCS) relies mainly on radiological criteria and clinical picture. The presence of a thickened filum terminale and a low-lying conus medullaris in symptomatic patients is indicative of TCS. The radiological definition of TCS does not take into account cases that involve a normal-lying conus medullaris exhibiting symptoms of the disease. Methods The authors performed a MEDLINE search using the terms “tethered cord” and “pathophysiology.” The search returned a total of 134 studies. The studies were further filtered to identify mostly basic research studies in animal models or studies related to the biomechanics of the filum terminale and spinal cord. Results Spinal cord traction and the loss of filum terminale elasticity are the triggers that start a cascade of events occurring at the metabolic and vascular levels leading to symptoms of the disease. Traction on the caudal cord results in decreased blood flow causing metabolic derangements that culminate in motor, sensory, and urinary neurological deficits. The untethering operation restores blood flow and reverses the clinical picture in most symptomatic cases. Conclusions Although classically defined as a disease of a low-lying conus medullaris, the pathophysiology of TCS is much more complex and is dependent on a structural abnormality, with concomitant altered metabolic and vascular sequelae. Given the complex mechanisms underlying TCS, it is not surprising that the radiological criteria do not adequately address all presentations of the disease.

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“…Acute tension on the spinal cord has been shown to produce spinal cord dysfunction and deranged metabolism in animal experiments, 15,23 but it is not known how these findings relate to the chronic situation typical of the patient with a tethered spinal cord. Superficial in vivo measurements of changes in cytochrome gradients 22 or laser Doppler blood flow 9 have been demonstrated in patients, but again the significance of these changes is not clear. Although increased tension on the conus from a thickened or fibrous filum 11 or asymmetric growth of the spine and spinal cord provides a plausible explanation for spinal cord dysfunction, plausibility does not equal causality.…”

Section: Tethered Spinal Cord Symptomatology Normal Imaging Findingsmentioning

confidence: 99%

Surgical management of the tethered spinal cord—walking the fine line

Drake¹

2007

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✓The tethered spinal cord is a fascinating yet controversial condition seen frequently in neurosurgical practice. Treatment decision making is made difficult by the variety of lesions and clinical presentations comprised by this condition and the absence of high-quality clinical outcome data to provide guidance. Clinical presentations may be divided into four general categories or typical scenarios: 1) significant dysraphic abnormality, clear clinical deterioration; 2) significant dysraphic abnormality, clinically normal or stable deficit; 3) incidentally discovered abnormality, other problem; and 4) tethered spinal cord symptomatology, normal imaging. The author provides case examples to illustrate potential treatment approaches and suggests balancing the risks and benefits for each general category. Clearer diagnostic and treatment strategies for the tethered spinal cord will only result from high-quality clinical and basic research. Until the results of such research are available, surgeons should endeavor to maximize benefit and reduce risk for patients who may have a tethered spinal cord, walking the fine line between over- and undertreatment.

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A Preliminary Report on the Use of Laser-Doppler Flowmetry during Tethered Spinal Cord Release

Cited by 53 publications

References 15 publications

Reversal of longstanding neurological deficits after a late release of tethered spinal cord

Reversal of longstanding neurological deficits after a late release of tethered spinal cord

Spinal cord traction, vascular compromise, hypoxia, and metabolic derangements in the pathophysiology of tethered cord syndrome

Surgical management of the tethered spinal cord—walking the fine line

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