Management of tethered cord syndrome in adults: a case report in Cameroon

Abstract

Tethered cord syndrome (TCS) is spinal cord fixation from multiple pathological entities. No case of TCShas been reported in our region. The goal of this case report was to describe a TCS managed at the Douala General hospital. Mrs. EEL, 23 year old consulted in 2012 for urinary and fecal incontinence. She had a past history of a spina bifida at birth operated on day two of life. On admission, lumbar MRI showed an abnormally low lying conus medullaris ending at S. Microsurgery permitted to gradually detach the spinal cord from subcutaneous tissue and carefully free the spinal nerves. A 12 months post-surgery, the patient could control defecation, and achieve proper micturition. TCS should also be ruled out in patients who present with urinary and ano-rectal symptoms especially of childhood onset; more so with present day availability of modern radiological tools like MRI.

Pattern and Management of Neural Tube Defect in Cameroon

“…A case of tethered cord syndrome (TCS) in an adult was reported in 2014 [10]. We undertook to carry out this study with particular emphasis on the diagnostic and therapeutic aspects to improve on the management of these neural tube defects in our country.…”

A Case of Lipomyelomeningocele Causing Equinovarus is Reported

“…[11]. Without timely intervention after the diagnosis of LMM, 90% of patients will develop irreversible progressive nerve damage [12]. In many studies, through the inference of the natural history of this disease, it was believed that: most patients' symptoms gradually aggravated with time, including lower limb movement disorder, muscle weakness, equinovarus and high arch, and the symptoms gradually aggravated, and at this time, surgery was the only effective way to treat the symptoms at present; However, postoperative dysfunction of urine and feces, especially bladder function, cannot be improved [13].…”

A Case of Lipomyelomeningocele Causing Equinovarus is Reported

“…Lipomyelomeningocele (LMM) is neural tube defects (NTD), the disease is due at 18 ~ 28 d, premature epithelial ectoderm from neural ectoderm, mesenchymal cells into developing neural tube, the formation of fat affect the spinal cord, the fat through the catheter into the subcutaneous tissue, the disease often occurs in women, more than 30% of patients can be characterized by abnormal skin,Such as mass, fur sinus, vascular malformation, etc., all suggest that the patient may have abnormal neural tube development such as LMM.It can also be manifested as nerve damage, such as tetheredcord syndrome (TCS), such as defecation and urination dysfunction, lower limb motor sensation disorder, sexual dysfunction, etc. [11].Without timely intervention after the diagnosis of LMM, 90% of patients will develop irreversible progressive nerve damage [12].In many studies, through the inference of the natural history of this disease, it was believed that: most patients' symptoms gradually aggravated with time, including lower limb movement disorder, muscle weakness, equinovarus and high arch, and the symptoms gradually aggravated, and at this time, surgery was the only effective way to treat the symptoms at present;However, postoperative dysfunction of urine and feces, especially bladder function, cannot be improved [13].Long-term follow-up observation is needed after LMM operation to monitor the occurrence of LMM.LMM can occur months to years after surgery, with an incidence of 5% ~ 50% [14], manifested by gradual aggravation of original symptoms or new symptoms, such as pain, incontinence, sexual dysfunction, and weakness of both legs.After the postoperative stability of the patient's symptoms, new neurological symptoms or aggravation of the original symptoms should be evaluated for the presence of LMM.MRI examination is an important evidence to determine the presence or absence of LMM. Based on the presence or absence of lower spinal cord, syringomyelia, etc., the patient must be combined with clinical symptoms to make a correct judgment.…”