Tethered cord syndrome in children with anorectal malformations

Muthukumar, Natarajan; Subramaniam, Bhuvaneswari; Gnanaseelan, Thangaraj; Rathinam, Ramesh; Thiruthavadoss, Appaswamy

doi:10.3171/jns.2000.92.4.0626

Cited by 24 publications

(12 citation statements)

References 24 publications

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“…An orthopedic lower extremity deformity or scoliosis may be apparent at an early age. The presence of an anorectal malformation should raise suspicion for a tethering lesion, as the incidence is high in these patients [22,23,24]. …”

Section: Diagnosismentioning

confidence: 99%

Tethered Cord Syndrome: An Updated Review

2007

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Tethered cord syndrome (TCS) is a diverse clinical entity characterized by symptoms and signs which are caused by excessive tension on the spinal cord. The majority of cases are related to spinal dysraphism. TCS can present in any age group, and presentations differ according to the underlying pathologic condition and age, with pain, cutaneous signs, orthopedic deformities and neurological deficits being the most common. Surgical untethering is indicated in patients with progressive or new onset symptomatology attributable to TCS. The surgical strategy aims to release the tethering structure and thus the chronic tension on the cord. Early operative intervention is associated with improved outcomes. Pain relief is accomplished in almost all cases. Realistic surgical goals include relief of pain and stabilization of neurological function, although improvement in function is often seen. Cord untethering can also halt the progression of scoliosis. The benefits of surgery are debated in asymptomatic patients and patients with normal imaging.

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Section: Diagnosismentioning

confidence: 99%

Tethered Cord Syndrome: An Updated Review

2007

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“…[6][7][8][9][10][11]13,17 Retethering is generally due to the formation of postoperative adhesions and fibrosis between the pial membrane and dura. 18,19 Retethering seems to occur more commonly in patients with complex lesions such as lipomyelomeningocoele or myelomeningocoele, possibly due to greater levels of inflammation or increased surgical scarring.…”

Section: Retetheringmentioning

confidence: 99%

“…[1][2][3][4][5] Unfortunately, retethering of the spinal cord after such surgery is relatively frequent. [6][7][8][9][10][11] We present a 31-year-old woman with diastematomyelia and recurrent ventral tethering of the spinal cord. An expanded polytetrafluoroethylene patch graft (Gore Preclude MVP Dura Substitute; WL Gore and Associates, Flagstaff, AZ, USA) was used to separate the cord from the ventral dura in an effort to prevent retethering.…”

Section: Introductionmentioning

confidence: 98%

Use of a synthetic dural substitute to prevent ventral retethering in the management of diastematomyelia

Shivapathasundram

Stoodley

2012

Journal of Clinical Neuroscience

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“…This may be as a result of increased tension, ischemia and traction of the spinal cord [2,3,4,5,6,7,8,9,10]. One popular etiology of a tethered cord in children is as a result of a fibrolipomatous filum terminale [2], where the filum terminale loses its normal configuration and elasticity due to fat infiltration.…”

Section: Introductionmentioning

confidence: 99%

Retethering in Children after Sectioning of the Filum Terminale

Vassilyadi¹,

Tataryn²,

Merziotis³

2012

Pediatr Neurosurg

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Background/Aim: Sectioning of the filum terminale is performed when spinal cord tethering is suspected, sometimes without clinical symptoms. Retethering can occur and require reoperation due to the presentation of either recurrent or new symptoms. The purpose of this institutional review was to identify the retethering rate in children, especially in those who were initially asymptomatic, and to discuss the role of surgery. Methods: The medical records of all children at the Children's Hospital of Eastern Ontario (CHEO) who underwent tethered cord surgery between 1978 and 2009 for a thickened filum terminale were retrospectively reviewed, as well as those who retethered. Results: A total of 146 patients with a mean age of 4.3 years underwent a low lumbar single or partial laminectomy for sectioning of the filum terminale; 44 patients (30.1%) were asymptomatic at the time of surgery, 51.4% had bladder and bowel dysfunction, 26.7% had neuroorthopedic findings, 15.8% had pain and 6.2% had progressive scoliosis; 11 children with a median age of 8.9 years had symptoms of retethering requiring reoperation (median time to retether was 4.3 years) and 4 were initially asymptomatic. Repeat surgery was successful at alleviating the new symptoms that occurred as a result of retethering. Conclusions: Of the 146 patients at CHEO who underwent surgery, 7.5% retethered, with 36% being initially asymptomatic. Those operated in the first year of life were not found to be at a higher risk. The level of the conus medullaris did not influence the rate or retethering or urological dysfunction. Children who were initially asymptomatic improved after surgery for retethering, but may not have required surgery in the first place.

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Tethered cord syndrome in children with anorectal malformations

Cited by 24 publications

References 24 publications

Tethered Cord Syndrome: An Updated Review

Tethered Cord Syndrome: An Updated Review

Use of a synthetic dural substitute to prevent ventral retethering in the management of diastematomyelia

Retethering in Children after Sectioning of the Filum Terminale

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