Tethered Cord Syndrome in Adults

Akay, Kamil Melih; Erşahin, Yusuf; Çakır, Yasemin

doi:10.1007/s007010070038

Cited by 51 publications

(52 citation statements)

References 21 publications

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“…18,20 Adults may also present because of retethering from scar tissue formation following an initial operation for spinal dysraphism. 1,6,11 Retethering is considered a relatively common postoperative complication following correction of pediatric spinal dysraphism. 6,9 No studies were found analyzing the pathophysiology of retethering following operative intervention of pediatric TCS and spinal dysraphism.…”

Section: Theorized Pathophysiology Based On Retrospective Analysismentioning

confidence: 99%

“…1,6,9,10,15 Unlike children, adult symptomatology is slightly different, with pain being the most common presenting symptom (rare in children 4 ), and this is followed by sensory disturbances, motor dysfunction and weakness, and urinary dysfunction. 1,2,13,15,18,20 Similar to the pediatric population, surgical intervention to release the adult tethered cord has proven to be successful in preventing further deterioration as well as sometimes improving symptoms and deficits. Thus, cord release has increasingly been accepted as a necessary intervention in symptomatic patients.…”

mentioning

confidence: 99%

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Pathophysiology of adult tethered cord syndrome: review of the literature

Stetler

Park²,

Sullivan³

2010

FOC

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Object Tethering of the spinal cord has been a recognized cause of neurological symptoms in pediatric patients and is increasingly being recognized as a cause of symptoms in adults as well. The pathophysiology surrounding spinal cord tethering has begun to be understood in the pediatric population but is still unclear in adult patients. Methods Using a PubMed database literature search, the authors reviewed the pathology and pathophysiology surrounding the tethered spinal cord, focusing particularly on the pathophysiology of adult tethered cord syndrome (TCS). Results Experimental data obtained in pediatric patients at surgery and in animal models indicate that spinal cord tethering causes a reduction in spinal cord blood flow and dysfunction of neuronal mitochondrial terminal oxidase. Retrospective analyses of patients undergoing surgery for adult TCS show that many adults developed symptoms following an event that could stretch the spinal cord, while others did not. Many patients also were found to have structural lesions in addition to a tethered spinal cord at diagnosis. Conclusions Both adult and pediatric TCSs are likely the result of a relative lack of blood flow to the spinal cord, causing dysfunction in mitochondrial oxidative phosphorylation. The likely reason the syndrome present later and differently in adults is that a secondary threshold of tension or a cumulative effect of repetitive, transient tension is placed on the cord before symptoms are recognized.

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Section: Theorized Pathophysiology Based On Retrospective Analysismentioning

confidence: 99%

mentioning

confidence: 99%

Pathophysiology of adult tethered cord syndrome: review of the literature

Stetler

Park²,

Sullivan³

2010

FOC

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“…From the original work of Pang and Wilberger 67 onward, many authors have commented on the roles of trauma and vigorous activity in the precipitation of symptoms and signs; 1,20,26 however, this association seems to be less prominent among adults with myelomeningocele and symptomatic secondary tethering. Pregnancy and childbirth likewise are described as destabilizing events among women with cord tethering, although most of the examples in the literature have been women with various forms of spina bifida occulta.…”

Section: Spinal Cord Tetheringmentioning

confidence: 99%

“…Pregnancy and childbirth likewise are described as destabilizing events among women with cord tethering, although most of the examples in the literature have been women with various forms of spina bifida occulta. 1,15,20,40,45,71,76 Pang and Wilberger 67 proposed that assuming the lithotomy position for pushing and delivery places the tethered spinal cord under tension. Alternatively, the general ligamentous relaxation that occurs late in pregnancy may alter the mechanics of the spine, or changes in adiposity or in pelvic venous pressure may affect the marginally perfused tethered cord.…”

Section: Spinal Cord Tetheringmentioning

confidence: 99%

Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults

Piatt¹

2010

PED

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Object Myelomeningocele is the most severe congenital malformation of the CNS that is compatible with survival. From the time of the development of practical treatment for hydrocephalus in the late 1950s, affected individuals began to survive into adulthood in substantial numbers. Data on the neurological status of these individuals are sparse, as are descriptions of their continuing requirements for neurosurgical care. Methods A review of the literature was undertaken using the PubMed database maintained by the National Library of Medicine. Formal grading of the quality of evidence was not attempted, but methodological issues affecting validity or generalizability were noted. Results Observations from 2 major longitudinal studies of cohorts of patients treated without selection using contemporary neurosurgical techniques have been published at intervals beginning in the mid-1970s. Numerous cross-sectional, institutional reviews have focused on neurosurgical issues in adulthood: hydrocephalus, Chiari malformation Type II and syringomyelia, and secondary spinal cord tethering. The organization of medical services for adults with myelomeningocele has received limited study. Conclusions Surviving adults with myelomeningocele achieve a wide range of neurological and functional outcomes, the most critical and adverse determinant of which is symptomatic CSF shunt failure. From a neurosurgical standpoint, adults with myelomeningocele remain clinically active indefinitely, and they deserve periodic neurosurgical surveillance.

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“…They compose 10% of the patients with spinal dysraphism at birth and are seen posteriorly in the cervical, thoracal, and lumbosacral regions 1 .…”

Section: Introductionmentioning

confidence: 99%

Erişkinde Lumbosakral Meningosel

Özdemir¹,

Atçı²,

Antar³

et al. 2015

Cukurova Medical Journal

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Spinal dysraphism is the incomplete fusion of the neural arch, which can be seen as an occult or open neural tube defect. Meningoceles are a form of open neural tube defect and characterized by cystic dilatation of the meninges containing cerebrospinal fluid (CSF), without the involvement of neural tissue. These lesions are often benign and typically diagnosed at birth. Neurosurgical intervention is necessary in the newborn period, since survival in advancing ages is often impossible. Therefore, meningoceles are rarely reported among spinal dysraphic lesions in adulthood. They are tethering lesions of the spinal cord, adhering to the dura and other soft tissues with fibrous elements. In addition, the caudal lesions tend to leak CSF, unlike cervical congenital midline meningoceles. Here, we present a 41 year-old female patient with a meningocele that has developed CSF leakage. The clinical course, surgical management, and follow-up period of this rarely seen adulthood meningocele are also discussed.

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Tethered Cord Syndrome in Adults

Abstract: The patients presenting with low back pain and sciatica responded to surgery better than those with sphincter problems.

Cited by 51 publications

References 21 publications

Pathophysiology of adult tethered cord syndrome: review of the literature

Pathophysiology of adult tethered cord syndrome: review of the literature

Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults

Erişkinde Lumbosakral Meningosel

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