Tethered Spinal Cord Following Meningomyelocele Repair

Thirty-two children with spinal dysraphism have been studied with phase MRI to assess longitudinal cord motion. Seventeen children who were asymptomatic and who had normal or slightly decreased motion were not operated. Fifteen had signs and symptoms of spinal cord tethering as well as decreased cord motion and underwent surgery. None of the nonsurgical patients have become symptomatic. The children with markedly decreased cord motion did not improve after surgery. A trend was seen toward a better outcome in younger patients with slight or moderate decrease in cord motion. All children with worse outcome were previously operated meningomyeloceles who had markedly decreased cord motion and who were greater than 10 years old.

Section: Discussionmentioning

confidence: 99%

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

Johnson

Levy

1995

“…Improved post-operative outcomes have been reported when this condition was repaired promptly after the appearance of symptoms [2, 5, 11, 15, 16]. Prophylactic surgery appears to have a superior outcome to operations that are performed after the appearance of neurological deficits [10, 15, 17], because not all patients regain function once symptoms appear. This may be due to a surgical trauma or post-operative complications.…”

Section: Discussionmentioning

confidence: 99%

Subacute Formation of Syrinx Post-Untethering of Spinal Cord

Grossman

Feldman

2004

Tethered spinal cord syndrome is characterized by a pathological fixation of the cord resulting in a low situated conus medullaris below the L1–2 interspace. With growth and development, this results in excessive cord stretching causing neuronal dysfunction. Untethering of the spinal cord aims to prevent the development of neurological or orthopedic sequelae which may arise if left untreated. Various complications of this operation have been described, including pseudomeningocele, CSF fistula, and meningitis. The authors present a case of a patient who developed a symptomatic syrinx, several days following untethering of the cord. Significant neurological improvement was achieved following revision surgery. This is the first case report of a syrinx developing several days post-untethering of the cord.

“…The size of the acoustic window, body habitus, scarring, and patient's age are, however, limitations that considerably restrict its accuracy and practical application [33][34][35]. Somatosenso ry evoked potentials and electromyography have been advocated as sensitive indicators of neurophysiological status in patients with tethered spinal cord [36] and also as tools in the follow-up of patients having undergone untethcring [6], The exact predictive value of this method in asymptomatic patients with signs of tethering on MRI has been questioned. Patient discomfort associated with this testing procedure has also been discussed [30,37], Cervical cord motion studies with phase-contrast MRI were reported to have an excellent predictive value in the management of tethered spinal cord [29,30,37].…”

Section: Discussionmentioning

confidence: 99%

Use of the Prone Position in the MRI Evaluation of Spinal Cord Retethering

Vernet

O’Gorman²,

Farmer³

et al. 1996

In order to determine the impact of magnetic resonance imaging (MRI) in the management of spinal cord retethering, we retrospectively reviewed case and imaging records of 51 patients who underwent MRI examination in supine and prone positions. Group 1 included 8 control patients without cord tethering. They exhibited a normal level of the conus medullaris with normal surrounding subarachnoid space, and consistent anterior migration of the conus within the dural sac on MRI in prone position. Group 2 included 17 patients with tethered cord secondary to occult spinal dysraphism (spinal cord lipoma in 6 patients, thick filum terminale in 4, diastematomyelia in 4, myelomeningocele manque in 2, and dermoid tumour in 1). Supine and prone MRI performed at a median period of time of 6 months after untethering showed resolution of posterior tethering in 5 out of the 7 patients who exhibited pre-opera-tively dorsal attachment of the spinal cord to the dura. Anterior migration of the conus or of the cord/filum complex in prone position was observed in only 24% of the cases. Group 3 included 26 patients with secondary tethered cord following prior myelomeningocele closure. Their MRI performed at a median interval of time of 11 months following untethering demonstrated resolution of the posterior cord tethering in only 8 out of the 24 patients who exhibited this feature pre-operatively. Anterior migration within the expanded dural sac was never noted in this group. We conclude that spine MRI is of limited value and that prone-positioned MRI is of no additional use in the evaluation of spinal cord retethering.