Congenital Cervical Tethered Spinal Cord in Adults: Recognition, Surgical Technique, and Literature Review
Arnold H Menezes1, Brian J Dlouhy1
1Department of Neurosurgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA.
Objective:
Recognition of congenital tethered cervical cord in adults and literature review.
Methods:
Retrospective review of adult onset tethered cervical cord patients (age >20 years).
Results:
Three adults were identified; 2 women and 1 man, average age 47 years. The presenting symptoms were neck pain with restricted movement (3), quadriparesis (2), and sensory changes (2). Hyperreflexia was present in all three. Bony abnormalities were mainly bifid cervical spinous processes (3), with Klippel-Feil abnormalities in 1. The neurocutaneous stigmata was seen in 2. Magnetic resonance imaging revealed "limited dorsal myeloschisis" in all 3 patients. The dorsal aspect of the cervical cord extruded into the tract leading to the surface.
Conclusions:
Neurocutaneous stigmata should not be considered benign. A missed clinical diagnosis was apparent in all 3 patients; 2 of whom underwent surgery with excellent results. Magnetic resonance imaging can identify the abnormal cervical cord protruding towards the "sinus tract" and allow planning to avert injury to the spinal cord during release.
