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Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Detethering of MRI-Demonstrated Tethered Cord Syndrome
Madeleine Howells1, Tyler Hamby1,2, John Honeycutt3
1Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA.
Insights
Tethered cord syndrome (TCS) in children often presents with constipation. Younger children (<5 years) show fewer symptoms, and while symptoms improve post-surgery, age and diagnostic factors do not influence this improvement.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Medicine
- Medical Imaging
Background:
- Tethered cord syndrome (TCS) in children can lead to neurological deficits as the spinal cord stretches with growth.
- Key imaging indicators include fatty/thickened filum or a conus medullaris below L2.
- Early recognition is crucial to prevent irreversible neurological damage.
Purpose of the Study:
- To characterize the symptomatic presentation of TCS in pediatric patients.
- To identify demographic and diagnostic predictors of symptoms and their changes over time.
- To evaluate symptom evolution following detethering surgery.
Main Methods:
- Retrospective chart review of 273 pediatric patients undergoing detethering surgery (April 2015 - March 2019).
- Analysis of presenting signs and symptoms, demographic data, and diagnostic findings (fatty/thickened filum, low-lying conus).
- Logistic regression used to identify predictors of symptoms and symptom changes.
Main Results:
- Younger children (<5 years) were less likely to present with urological, gastrointestinal, or neurological/orthopedic symptoms.
- Thickened filum was associated with fewer urological symptoms; low-lying conus with fewer gastrointestinal symptoms.
- Intractable constipation was a common presentation (45%); symptoms generally reduced post-surgery, independent of patient characteristics.
Conclusions:
- Constipation is a frequent presenting symptom of TCS in children.
- Clinical manifestation of TCS varies with age, with younger children exhibiting fewer symptoms.
- Symptom improvement is observed post-detethering, but demographic and diagnostic factors do not predict this change.
Introduction:
Recognition of tethered cord syndrome (TCS) in children is important because as the child grows, the spinal cord is stretched, leading to ischemia and subsequent neurological deficits, including bowel or bladder dysfunction, back and leg pain, or lower extremity weakness. Imaging findings raising concerns for tethering include presence of a fatty and/or thickened filum or a conus medullaris located caudal to L2.
Objectives:
The objective of this study was to describe the symptomatic presentation of TCS in our institution, detect demographic and diagnostic predictors of signs and symptoms, assess changes in symptoms over time, and examine whether demographic and diagnostic variables affect changes in symptoms over time.
Methods:
Using a retrospective chart review from patients who underwent detethering at our institution between April 1, 2015 and March 31, 2019, we report on the signs and symptoms of patients undergoing detethering surgery at presentation and examine possible demographic and diagnostic predictors of those symptoms and changes in symptoms over time. Logistic regression analyses were used to determine whether symptoms at presentation were related to demographic and diagnostic predictors and to assess a change in symptoms over time.
Results:
A total of 273 patients underwent detethering and were analyzed. Of these, 144 (53%) were <5 years of age, 151 (55%) were male, 233 (85%) had a fatty filum, 179 (66%) had a thickened filum, and 106 (39%) had a low-lying conus. Patients <5 years of age were less likely to have urological, gastrointestinal, and neurological or orthopedic symptoms; patients with thickened fila (i.e., greater than 2 mm in diameter regardless of fat-infiltration) were less likely to have urological symptoms; and patients with low-lying coni were less likely to have gastrointestinal symptoms. Patients exhibiting symptoms at presentation had reduced rates of symptoms at the follow-up, but a reduction in rates of symptoms over time was unrelated to demographic or diagnostic variables. Surprisingly, 123 (45%) patients presented with intractable constipation.
Conclusion:
In the population studied, several presenting symptoms, particularly constipation, were commonly reported. Children <5 years old were less likely to manifest clinically evident neurological/orthopedic, urological, and gastrointestinal symptoms than the older cohorts. Patients were less likely to report symptoms at both their first and second postoperative visit compared to presentation.
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