Tethered Cord Syndrome: Clinical Signs and Results of Operation in 42 Patients with Spina Bifida Aperta and Occulta

Abstract

The results of tethered spinal cord operations in 42 patients were evaluated. Over a period of 10 years, 20 spina bifida occulta (S.B.O.) and 22 spina bifida aperta (S.B.A.) patients were operated. In the S.B.O. group 6 patients were operated when young in order to prevent neurological deterioration. With a mean follow-up of 3 years they developed no new neurological symptoms. The clinical symptoms and the age at which the neurological deterioration occurred was quite similar in the S.B.O. and S.B.A. patients. Motor dysfunction and pain in back and/or legs were the most frequent symptoms. The postoperative complication rate was low. The purpose of surgery was to stop further neurological deterioration. The operative results were slightly better in the S.B.A. group than with the S.B.O. group. In both groups of patients it was evident that operation at an older age after a long period of complaints was associated with less favourable postoperative results. The surgical treatment of a tethered spinal cord syndrome in patients with spina bifida aperta is no more risk than an operation in spina bifida occulta patients.

Spinal cord ultrasonography in children with myelomeningocele

“…As surprising as this finding may seem, it is quite consistent with the common clinical finding of subjects with a wide range of ages presenting with S-TCS. This is reported in many series in the literature (Park et al 1985;Begeer et al 1986Begeer et al , 1989McLone et al 1990-91;Lais et al 1993). It seems legitimate to conclude from this finding that growth-dependent overstretching of the cord is not a solitary causative factor in the development of clinical deterioration in patients with MMC.…”

“…Despite the findings of tethered cord in almost all children with MMC, the relatively low incidence of the S-TCS (10 to 30% in various series) (Begeer et al 1986(Begeer et al , 1989McLone 1992) suggests that the cause of the clinical change is not tethering of the cord per se, but that additional factors are involved. The common findings of brain and spinal cord abnormalities in conjunction with tethered cord in these patients may indicate that these abnormalities are involved in causing the clinical change in patients with MMC.…”

Analysis of different treatment modalities of tethered cord syndrome

“…Therefore prophylactic surgery can be carried out safely, and it may have a role in the prevention of symptoms among these young patients. Many authors have emphasized that early operation leads to a better outcome [2,8,10,11,12,17], which would provide support for a policy of prophylactic detethering. Long-term follow up is required to evaluate prophylactic surgery.…”

Spinal lipomas

“…Generalized low-back pain, radicular leg pain, which may vary in distribution with time, and Lhermitte sign have all been described. 6,11,43,52 Often such pain is precipitated by physical exertion, traumatic injury, or direct contact, but spontaneous symptoms may occur as well.…”