[Tethered cord syndrome in adults]

A series of 25 adult patients surgically treated for a tethred cord syndrome is reported. Preoperatively 19 patients presented with a sensorimotor deficit in their lower limbs, 17 with sphincter disturbances, 12 with pain and/or neuroorthopedic symptoms and 9 with cutaneous lumbar anomalies. At surgery, an isolated anomaly (lipoma, anomalous or adherent filum terminale) was disclosed in 18 patients. In the remaining 7, a more complex form of dysraphism was disclosed. Follow-up ranges from 3 months to 20 years (mean: 6.5 years). Ten patients improved, 6 were stabilized and 9 showed continuous worsening. The best results were obtained in patients in whom the cord tethering resulted from an anomalous filum terminale. Results were significantly worse in patients suffering long standing symptomatology and showing either radiologically or surgically mixed mechanisms of cord tethering. Early surgical correction should be idealy undertaken in patients suffering from minor neurological deficits and in whom magnetic resonance imaging illustrates a low conus medullaris attached by a short thickened filum terminale.