title: Tethered cord syndrome in adulthood.
abstract: OBJECTIVE
  The standard treatment for tethered cord syndrome (operative vs nonoperative management) that presents in adulthood remains controversial. A comparative study of tethered cord syndrome in adulthood is needed.
  
  
  METHODS
  A retrospective chart-based analysis.
  
  
  METHODS
  Patients admitted to Gulhane Military Medical Academy Department of Neurosurgery for management of caudal spinal cord tethering from June 1999 through December 2006 (N = 22).
  
  
  RESULTS
  Conus level was normal in 1 patient with split cord malformation and dermal sinus. Tight terminal filum was found in 21 patients, including postrepair myelomeningocele tethered cord in 4, lipomyelomeningocele/meningocele in 8, split cord malformation in 3, dermal sinus in 7, and syringomyelia in 3. The most common complaints were back pain (15 patients, 68.1%), bladder dysfunction (8, 36.3%), fecal incontinence (2, 9.09%), and leg pain (7, 31.8%). One patient had hydrocephalus (4.5%). Ten of 22 patients underwent surgery; 8 of 10 patients had detethering; and 12 patients refused surgery. Postoperative cerebrospinal fluid leakage requiring reinforcement sutures occurred in 1 patient. There were no infectious complications. Neurologic status and outcomes were compared with preoperative findings.
  
  
  CONCLUSIONS
  Some patients refuse surgery despite severe neurologic disturbances. Neurosurgeons should fully explain the risks and benefits of surgery for tethered cord to the patient and family. A much larger and prospective randomized series is needed to determine the effects of operative vs nonoperative management of tethered cord syndrome in adulthood.
authors.affiliation: Department of Neurosurgery, Gulhane Miltary Medical Academy (GATA), Etlik, Ankara, Turkey. bduz@gata.edu.tr
authors.forename: Bulent
authors.initials: B
authors.lastname: Düz
authors.forename: Selcuk
authors.initials: S
authors.lastname: Gocmen
authors.forename: Halil Ibrahim
authors.initials: HI
authors.lastname: Secer
authors.forename: Seref
authors.initials: S
authors.lastname: Basal
authors.forename: Engin
authors.initials: E
authors.lastname: Gönül
mesh_terms: D000328:Adult; D001416:Back Pain / Q000209:etiology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008588:Meningocele / Q000209:etiology; D009436:Neural Tube Defects / Q000150:complications / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies
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