Primary Tethered Cord Syndrome - Clinical and Urological Manifestations, Diagnosis and Management: A Prospective Study

Abstract

Primary tethered cord syndrome refers to a group of neural tube defects that are not externally obvious, and, if detected at an early age, surgical intervention may prevent the significant irreversible neurological deficits. This study was performed to evaluate the presenting clinical features of patients with primary tethered cord syndrome and the indications of surgery in such patients as well as the clinical and urological outcome. In all cases, the indication for surgery was the presence of a tethered cord on magnetic resonance imaging, the criteria for tethering being a low-lying conus (below L₁-L₂) and a thickened filum (>2 mm). Urodynamic studies were performed before detethering. Microsurgical detethering of low-lying cord was then performed, and the patients were then followed clinically and urologically for 6 months. Pain responded the most to detethering while limb weakness and urological symptoms responded the least. Clinical improvement in urological symptoms correlated with improvement in urodynamic parameters. A urodynamic study identified improvement in a larger number of patients and also deterioration in a few patients which was not visible clinically; this may point to its high sensitivity and usefulness in preceding clinical manifestations in a future follow-up.

Evaluation and management of tethered cord syndrome in occult spinal dysraphism: Recommendations from the international children's continence society

“…Urologic evaluation in OSD is an important component for treatment decisions and the gold standard remains UDS (cystometrography [CMG] and sphincter electromyography [EMG]). [33][34][35][36] When carefully performed, UDS yields information about lower urinary tract (LUT) function that guides neurosurgeons' decisions to operate and serves as a basis for comparison of surgical outcomes. 37 CMG reveals bladder reactivity when it is artificially filled and when it empties.…”

Disparities in clinical and economic outcomes in children and adolescents following surgery for tethered cord syndrome in the United States

“…There was a slight female preponderance in this study group, consistent with findings of Kanev et al and Lad et al 6,7 However, more studies are needed to confirm this in the pediatric population as some studies indicate some variability in sex prevalence. 1,9 Additionally, multiple studies (including this analysis) have shown much greater prevalence in Caucasians/whites compared with other races and ethnicities (64.4%, Table 2). 7 Of the patients analyzed, 7.2% had complications following initial spinal laminectomy.…”

“…Such symptoms include neurogenic bladder, weakness, numbness, spasticity, spinal deformities, deformities in feet, and skin lesions. 1,4,9 Surgical release is an option that is widely practiced by pediatric neurosurgeons. From this descriptive analysis, we have identified patient age and the presence of comorbidities to be factors affecting surgical outcomes in children and adolescents undergoing surgical intervention for TCS.…”

“…In addition to age, the number of compounding comorbidities present increases the risk for postoperative complications, consistent with the multivariate analysis conducted by Lad et al Bui et al 2 summarized the common comorbidities in patients with TCS, which can include cutaneous manifestations, orthopedic abnormalities (i.e., leg-length discrepancy, foot asymmetry, foot deformity, and progressive scoliosis), and urological problems (i.e., neurogenic bladder, incontinence, and frequent urinary 2 Other common comorbidities include degenerative disc disease, spinal stenosis and spondylosis, anorectal abnormalities, split cord malformation, OEIS syndrome (omphalocele, extrophy of the cloaca, imperforate anus, and spinal malformations with TCS), VATER associations, and the Currarino triad (anorectal malformation, presacral mass, and sacral bone abnormalities). 1,3,8,910 To date, no large-scale study has been conducted to determine the prevalence of these comorbid conditions with TCS.…”

Screening and Treatment of Tethered Spinal Cord in Anorectal Malformation Patients

“…8,9 There is a clear consensus that patients with tethered cord syndrome should be surgically untethered to prevent further deterioration, as a clinical response has been reported in 44 to 67%. 8,10 In view of the high occurrence of TSC in ARM patients and because of the fact that early symptoms of tethered cord syndrome, such as urinary incontinence, may be difficult to recognize in ARM patients due to associated anomalies of urogenital or renal origin, all ARM patients in our hospital are screened for TSC in the neonatal period using spinal ultrasonography. The aim of this study was to evaluate diagnosis and treatment of TSC in ARM patients by determining the sensitivity and specificity of spinal ultrasonography with MRI as the golden standard.…”