J Korean Neurosurg Soc.  2009 Nov;46(5):468-471. 10.3340/jkns.2009.46.5.468.

Surgical Management and Outcome of Tethered Cord Syndrome in School-Aged Children, Adolescents, and Young Adults

• Kang JK
• Yoon KJ
• Ha SS
• Lee IW
• Jeun SS
• Kang SG

• KMID: 2190077
• DOI: http://doi.org/10.3340/jkns.2009.46.5.468

Abstract

OBJECTIVE
The adolescent presentation of tethered cord syndrome (TCS) is well-recognized, but continues to pose significant diagnostic and management controversies. The authors conducted a retrospective study of clinical outcomes after surgical intervention in 24 school-aged children, adolescents, and young adults with TCS.
METHODS
All 83 patients with a lipomyelomeningocele (LMMC) underwent untethering surgery for caudal cord tethering between 1987 and 2007. The clinical charts and follow-up data were reviewed. Of these patients, 24 school-aged children, adolescents, and young adults with TCS were studied with respect to the clinical, radiologic, pathologic features, and surgical outcomes.
RESULTS
Untethering procedures were performed in 24 patients (age range, 7-25 years) for TCS of various origins (lipoma, lipomyelomeningocele, and tight filum terminale). Specific circumstances involving additional tugging of the already tight conus, and direct trauma to the back precipitated the onset of symptom in 50% of the patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities, as well as bladder and bowel dysfunction, were also common findings, but progressive foot and spinal deformities were noted less frequently. The most common tethered lesions were intradural lipomas, thickened filum and fibrous band adhesions into the placode sac. The surgical outcome was gratifying in relation to pain and motor weakness, but disappointing with respect to resolution of bowel and bladder dysfunction. Of the 24 patients with TCS, pre-operative deficits improved after surgery in 14 (58.3%), remained stable in 8 (33.4%), and worsened in 2 (8.3%).
CONCLUSION
The pathologic lesions of tethered cord syndrome in school-aged children, adolescents, and young adults, are mostly intradural lipomas and tight filum. It is suggested that the degree of cord traction results in neurologic dysfunction in late life due to abnormal tension, aggravated by trauma or repeated tugging of the conus during exercise. Early diagnosis and adequate surgical release might be the keys to the successful outcome in school-aged children, adolescents, and young adults with TCS.

Keyword

Adolescent; Intraspinal lipoma; School-aged children; Surgical outcome; Tethered cord syndrome; Young adults

MeSH Terms

Adolescent
Child
Congenital Abnormalities
Conus Snail
Early Diagnosis
Follow-Up Studies
Foot
Humans
Leg
Lipoma
Lower Extremity
Meningomyelocele
Neural Tube Defects
Neurologic Manifestations
Retrospective Studies
Traction
Urinary Bladder
Young Adult
Meningomyelocele