[Diagnosis and treatment of tethered spinal cord syndrome--based on experience of 77 cases].
Since 1976, the author has experienced 77 cases that have been diagnosed as the tethered spinal cord syndrome. These cases could be divided into two groups by the relative level of conus medullaris to that of L3 body, i.e. 34 cases in which the conus medullaris is tethered below the superior border of L3 body were classified into low placed conus medullaris (LPCM) and 43 in which the conus medullaris is located above the same level into the tight filum terminale (TFT). As to symptoms and signs, incontinence, gait disturbance, foot and toe deformities, lumbosacral tumor and sacral dimple were seen more often in the LPCM group. On the other hand, nocturia, pain in the back and in the lower limbs, positive Lasègue sign and tight back were seen more often in the TFT group. Neurological signs were seen more often in the LPCM group. In 3 cases of LPCM, and 10 of TFT, spina bifida was not visualized on the plain X-ray film of the spinal column. LPCM could be definitively diagnosed by myelography taken with the patient lying in the supine position, on the other hand myelography did not always give definitive diagnosis of TFT. Surgery for releasing the tethering conus was carried out in 58 of 77 cases. Of which 49 have been followed up more than 2 months after operation. Some degree of improvement of various symptomes and signs, was noted in 35 (68%) of these patients.
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008067:Lipoma / Q000150:complications; D008297:Male; D008875:Middle Aged; D009192:Myelography; D012026:Reflex, Stretch; D012677:Sensation / Q000502:physiology; D016136:Spina Bifida Occulta / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D013116:Spinal Cord / Q000002:abnormalities*; D013120:Spinal Cord Neoplasms / Q000150:complications; D013577:Syndrome; D014555:Urination Disorders / Q000150:complications