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Tethered cord syndrome.

F Rinaldi1, F A Cioffi, L Columbano

  • 1Department of Neuroradiology, Second University of Naples Medical School, Naples, Italy.

Journal of Neurosurgical Sciences
|December 24, 2005
PubMed
Summary
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Tethered cord syndrome (TCS) can manifest in adulthood with neurological deficits. Early diagnosis and surgical untethering are crucial for improving symptoms and preventing permanent disability.

Area of Science:

  • Neurology
  • Neurosurgery
  • Pediatric Neurology

Background:

  • Tethered cord syndrome (TCS) is a spinal cord disorder caused by inelastic structures, often a short filum terminale, anchoring the spinal cord.
  • Associated conditions like spinal dysraphism, hydromielia, and Arnold-Chiari malformation can occur, but their etiological link to TCS requires further clarification.

Purpose of the Study:

  • To analyze neuroradiological findings in pediatric and adult patients with TCS.
  • To establish precise diagnostic criteria and therapeutic strategies, including conservative and surgical options.

Main Methods:

  • Retrospective analysis of neuroradiological findings in 14 patients (5 children, 9 adults).
  • Inclusion criteria: neurological disturbances at the conus medullaris level and evidence of spinal dysraphism.

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  • Diagnostic modalities included X-ray, CT, CT-myelography, and MRI, with MRI identified as the preferred method.
  • Main Results:

    • TCS diagnosis typically occurs in childhood but can present insidiously in adulthood with symptoms like gait disturbances, muscle atrophy, sensory loss, and pain.
    • MRI is the diagnostic method of choice.
    • Surgical untethering is recommended and can improve pain, ambulation, and bladder function.

    Conclusions:

    • Sphincter dysfunction may persist even after surgery.
    • Prophylactic surgery is advisable due to the risk of rapid deterioration and incomplete neurological recovery.
    • Long-term follow-up is essential for patients, especially those not undergoing surgery.