Surgical management and outcome of tethered cord syndrome in school-aged children, adolescents, and young adults

Joon Ki Kang, Kang Jun Yoon, Sang Su Ha, Il Woo Lee, Sin Soo Jeun, Seok-Gu Kang

Research output: Contribution to journalArticle

18 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)468-471
Number of pages4
JournalJournal of Korean Neurosurgical Society
Volume46
Issue number5
DOIs
Publication statusPublished - 2009 Dec 1

Fingerprint

Neural Tube Defects
Young Adult
Lipoma
Urinary Bladder
Referred Pain
Foot Deformities
Cauda Equina
Wounds and Injuries
Traction
Neurologic Manifestations
Early Diagnosis
Lower Extremity
Leg
Retrospective Studies
Exercise
Pain

All Science Journal Classification (ASJC) codes

  • Surgery
  • Neuroscience(all)
  • Clinical Neurology

Cite this

Kang, Joon Ki ; Yoon, Kang Jun ; Ha, Sang Su ; Lee, Il Woo ; Jeun, Sin Soo ; Kang, Seok-Gu. / Surgical management and outcome of tethered cord syndrome in school-aged children, adolescents, and young adults. In: Journal of Korean Neurosurgical Society. 2009 ; Vol. 46, No. 5. pp. 468-471.
@article{802ce1f191ed44b4b0f6bf5453415d1c,
title = "Surgical management and outcome of tethered cord syndrome in school-aged children, adolescents, and young adults",
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.",
author = "Kang, {Joon Ki} and Yoon, {Kang Jun} and Ha, {Sang Su} and Lee, {Il Woo} and Jeun, {Sin Soo} and Seok-Gu Kang",
year = "2009",
month = "12",
day = "1",
doi = "10.3340/jkns.2009.46.5.468",
language = "English",
volume = "46",
pages = "468--471",
journal = "Journal of Korean Neurosurgical Society",
issn = "2005-3711",
publisher = "Daehan sin'gyeong oe'gwa haghoe",
number = "5",

}

Surgical management and outcome of tethered cord syndrome in school-aged children, adolescents, and young adults. / Kang, Joon Ki; Yoon, Kang Jun; Ha, Sang Su; Lee, Il Woo; Jeun, Sin Soo; Kang, Seok-Gu.

In: Journal of Korean Neurosurgical Society, Vol. 46, No. 5, 01.12.2009, p. 468-471.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Surgical management and outcome of tethered cord syndrome in school-aged children, adolescents, and young adults

AU - Kang, Joon Ki

AU - Yoon, Kang Jun

AU - Ha, Sang Su

AU - Lee, Il Woo

AU - Jeun, Sin Soo

AU - Kang, Seok-Gu

PY - 2009/12/1

Y1 - 2009/12/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=73649140982&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=73649140982&partnerID=8YFLogxK

U2 - 10.3340/jkns.2009.46.5.468

DO - 10.3340/jkns.2009.46.5.468

M3 - Article

VL - 46

SP - 468

EP - 471

JO - Journal of Korean Neurosurgical Society

JF - Journal of Korean Neurosurgical Society

SN - 2005-3711

IS - 5

ER -