Predicting Outcome in the Tethered Cord Syndrome: A Study of Cord Motion

Johnson, Dennis L.; Levy, Lucien M.

doi:10.1159/000120888

Cited by 31 publications

(11 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9,33,35,50 Dysraphic lesions cause symptoms by attaching the spinal cord to a fixed vertebral structure. The spinal cord is stretched and cord motion is decreased, 20,53 leading to impaired cellular metabolism and neuronal function. 55 Particularly in adults, associated conditions may lead to spinal cord dysfunction when tethering is present.…”

Section: Scientific Foundationmentioning

confidence: 99%

Adult tethered cord syndrome in patients with postrepair myelomeningocele: an evidence-based outcome study

George

Fagan

2005

Journal of Neurosurgery

View full text Add to dashboard Cite

Analysis of the available data indicates the following. (1) A lower lesion level predisposes patients to symptomatic tethering; moreover, orthopedic and urological deterioration will occur in the majority of these patients. (2) Tethered cord release should be considered for adult patients with postrepair myelomeningocele when clinical symptoms, imaging studies, urodynamics, and somatosensory evoked potentials are consistent with TCS. (3) Prompt, aggressive untethering surgery within 5 years of symptom onset, along with long-term follow up to check for delayed retethering, is recommended. The overall outcome for patients with postrepair myelomeningocele may not be as good as the outcome for adults with closed dysraphism.

show abstract

Section: Scientific Foundationmentioning

confidence: 99%

Adult tethered cord syndrome in patients with postrepair myelomeningocele: an evidence-based outcome study

George

Fagan

2005

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…As the section of the vertebral canal between the L-1 and S-2 vertebrae increases its original length by 8%, the filum terminale must accommodate to this lengthening without transmitting any tethering force to the conus medullaris [13]. There are also reports that the spinal cord has free vertical movements during heartbeat, coughing or straining [4]. There are also reports that the spinal cord has free vertical movements during heartbeat, coughing or straining [4].…”

Section: Introductionmentioning

confidence: 99%

Is a filum terminale with a normal appearance really normal?

Selçukı

Vatansever²,

İnan³

et al. 2003

Childs Nerv Syst

View full text Add to dashboard Cite

Introduction: Tethered spinal cord is defined as a condition in which the conus medullaris ends at a level below the L1-2 intervertebral space. The spinal cord is considered to be tethered when there is a thick filum terminale or low-lying conus medullaris. It has also been reported that a normal level of the conus medullaris and normal thickness of the filum terminale do not mean that there is no cord tethering. Materials and methods: In this investigation, we examined 21 fila terminalia; 5 of them were taken from cadavers, and these were used as a control group (group 1; n/n), 8 from patients with a normal appearance of the filum terminale but with clinical symptoms (incontinence) and pathologic results of a urodynamic study (group 2; n/ab), and 8 from patients with an abnormal appearance of the filum terminale and with clinical symptoms (group 3; ab/ab). Interestingly, we found that while fila terminalia in the control group were made up mainly of collagen fibers, more connective tissue with dense colla-gen fibers, some hyalinization and dilated capillaries were noticed in the fila from group 2. Results: Our results suggest that these histological features may reflect a decreased elasticity within the filum terminale, resulting in a tethering effect on the lower conus in otherwise normal physiological conditions. Conclusion: These findings lead us to reconsider sectioning of the filum terminale in incontinent patients with normal results in radiological studies, whose condition is called "nonneurogenic neurogenic bladder."

show abstract

“…Taking into account a rate of 14 % of surgery-related deterioration and 8 % of relevant complications, we still need more sensitive criteria to determine the individual risk of an unfavorable natural course [21] in order to justify surgery prior to clinical deterioration [5]. Such criteria may in the future be provided by regular electrophysiological assessment [28] and motion analyses performed using ultrasound or magnetic resonance imaginge [12,31].…”

Section: Discussionmentioning

confidence: 99%

Surgical Aspects and Outcome of Delayed Tethered Cord Release

Haberl

Tallen

Michael

et al. 2004

Zentralbl Neurochir

View full text Add to dashboard Cite

Out of a total of 550 children followed up at our spina bifida center, we report on 81 patients who were reoperated upon for secondary tethered cord syndrome between 1993 and 2000. In four cases with preceding severe progressive scoliosis, untethering was followed by surgical correction and stabilization of curvatures. In 77 patients, the indication for surgery was based on late progressive neurological deterioration. The current clinical relevance of competing etiologic factors such as symptomatic Chiari malformation, hydromyelia, and shunt dysfunction, requiring different clinical management, had been previously carefully excluded. The children underwent magnetic resonance imaging (MRI) or myelo-computed tomography (m-CT) to identify the morphologic extent of tethering and any associated spinal malformations such as dermoid tumors (19 cases) or diastematomyelia (9 cases). Surgery became faster and safer through bilateral dural incision, undercutting arachnoid adhesions along the tethered area, although this procedure increased the need for dural grafting. Complete release of the conus medullaris and cauda equina was achieved in a total of 75 cases (93 %) including those who had undergone prophylactic surgery. A mean follow-up of 4.8 years in 77 patients operated upon for late progressive neurological deterioration confirmed stabilization of presenting symptoms in 65 cases (84 %) with 20 of them (26 %) even showing significant improvement. In 12 patients (16 %), including all cases of incomplete untethering (n = 4), there was further deterioration.

show abstract

Predicting Outcome in the Tethered Cord Syndrome: A Study of Cord Motion

Cited by 31 publications

References 9 publications

Adult tethered cord syndrome in patients with postrepair myelomeningocele: an evidence-based outcome study

Adult tethered cord syndrome in patients with postrepair myelomeningocele: an evidence-based outcome study

Is a filum terminale with a normal appearance really normal?

Surgical Aspects and Outcome of Delayed Tethered Cord Release

Contact Info

Product

Resources

About