The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Orthopedic Lesions in Tethered Cord Syndrome: The Importance of Early Diagnosis and Treatment on Patient Outcome

Document Type : RESEARCH PAPER

Authors
Mohammad Gharedaghi 1
Fariborz Samini 2
Hosein Mashhadinejad 2
Mahdi Khajavi 3
Mohammad Samini 4
1 Orthopedic Research Center, Department of Orthopedic Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Orthopedic Research Center, Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
4 Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/abjs.2014.3072
Abstract
Background:
 
Many of the patients with tethered cord syndrome (TCS) are admitted because of neurological symptoms, while some are admitted because of their orthopedic, urologic, anorectal, and dermatologic manifestations.Consequently, this study aimed to evaluate the importance of early diagnosis and treatment of tethered cord syndrome on patient outcome.
Methods:
Fourty-three patients who underwent surgery because of tethered cord syndrome from 2006 to 2010 were studied. Many of these cases were referred by orthopedic surgeons. All of the findings were recorded and follow up was done twice (1 and 3 years after surgery).
Results:
Thirty-seven patients were less than 7 years old and 6 were between 17 to 33 years old. According to clinical and neurological exams, satisfactory results were achieved in both groups. Those with early surgical intervention, especially in their early follow up assessment, had the best results. Seventeen cases were referred by an orthopedic surgeon because of manifestations such as leg weakness and numbness, leg pain and spasticity, pes cavus, claw toes, and leg or foot length discrepancy. Cerebrospinal fluid leakage occurred in 3 cases after surgery and 1 showed pseudomeningocele formation.
Conclusions:
After one year of follow up, initially the results of the treatment were better in early operated cases, but in later follow up assessment (after 3 years) the results were almost the same in both of the groups.
 
 
Keywords
Orthopedic lesionsn
Tethered cord syndrome
Tight filum terminale

  1. Pinto FC, Fontes RB, Leonhardt Mde C, Amodio DT, PorroFF, Machado J. Anatomic study of the filum terminale and its correlations with the tethered cord syndrome. Neurosurgery. 2002; 51(3):725 -9.

  2. Tu A, Steinbok P. Occult tethered cord syndrome: a review. Childs Nerv Syst. 2013;29(9):1635-40.  

  3. Akay KM, Ersahin Y, Cakir Y. Tethered cord syndrome in adults. Acta Neurochir. 2000; 142(10):1111-5.

  4. Kural C, Guresci S, Simsek GG, Arslan E, Tehli O, Solmaz I,  et al. Histological structure of filum terminale in human fetuses. J Neurosurg Pediatr. 2014; 13(4): 362-7.

  5. Chern JJ, Dauser RC, Whitehead WE, Curry DJ, Luerssen TG, Jea A. The Effect of Tethered Cord Release on Coronal Spinal Balance in Tight Filum Terminale. Spine. 2011;36(14):944-9.

  6. Krassioukov AV, Sarjeant R, Arkia H, Fehlings MG. Multimodality intraoperative monitoring during complex lumbosacral procedures: indications, techniques, and long-term follow-up review of 61 consecutive cases. J Spine Neurosurg. 2004; 1(3): 243–53.

  7. Yamada S, Siddiqi J, Won DJ, Kido DK, Hadden A, Spitalieri J, et al. Symptomatic protocols for adult tethered cord syndrome. Neurol Res. 2004; 26(7): 741-4.

  8. Cornips EM, Vereijken IM, Beuls EA, Weber JW, Soudant DL, van Rhijn LW, et al. Clinical characteristics and surgical outcome in 25 cases of childhood tight filum syndrome. Eur J Paediatr Neurol. 2012; 16(2):103-17.

  9. Swaroop VT, Dias L. Orthopaedic management of spina bifida-part II: foot and ankle deformities. J Child Orthop. 2011; 5(6):403-14. 

  10. Bowman RM, Mohan A, Ito J, Seibly JM, McLone DG. Tethered cord release: a long-term study in 114 patients. J Neurosurg Pediatr. 2009; 3(3):181-7.

  11. Sanchez T, John RM. Early Identification of Tethered Cord Syndrome: A Clinical Challenge.J Pediatr Health Care. 2014; 28(3):23-33. 

  12. Ailawadhi P, Kale SS, Agrawal D, Mahapatra AK, Kumar R. Primary tethered cord syndrome--clinical and urological manifestations, diagnosis and management: a prospective study. Pediatr Neurosurg. 2012; 48(4):210-5. 

  13. Lew SM, Kothbauer KF. Tethered cord syndrome: an updated review. Pediatr Neurosurg. 2007; 43(3):236-48.

  14. Filippidis AS, Kalani MY, Theodore N, Rekate HL. Spinal cord traction, vascular compromise, hypoxia, and metabolic derangements in the pathophysiology of tethered cord syndrome. Neurosurg Focus. 2010; 29(1):9.

  15. Stavrinou P, Kunz M, Lehner M, Heger A, Müller-Felber W, Tonn JC, et al. Children with tethered cord syndrome of different etiology benefit from microsurgery-a single institution experience. Childs Nerv Syst. 2011; 27(5):803-10.

  16. Cools MJ, Al-Holou WN, Stetler WR Jr, Wilson TJ, Muraszko KM, Ibrahim M, et al. Filum terminale lipomas: imaging prevalence, natural history, and conus position. J Neurosurg Pediatr. 2014; 13(5):559-67. 

  17. Agarwalla PK, Dunn IF, Scott RM, Smith ER. Tethered cord syndrome. Neurosur Clin N Am. 2007;18(3):531-47.

  18. Yong RL, Habrock-Bach T, Vaughan M, Kestle JR, Steinbok P. Symptomatic Retethering of the Spinal Cord Following Section of a Tight Filum Terminale. Neurosurgery. 2011; 68(6):1594-601.

  19. Haq I, Cruz-Almeida Y, Siqueira EB, Norenberg M, Green BA, Levi AD. Postoperative fibrosis after surgical treatment of the porcine spinal cord: a comparison of dural substitutes. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2005; 2(1):50-4.

  • Receive Date 08 February 2014
  • Revise Date 19 April 2014
  • Accept Date 17 June 2014