Tethered cord syndrome in adulthood.
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.
Düz
Bulent
B
Department of Neurosurgery, Gulhane Miltary Medical Academy (GATA), Etlik, Ankara, Turkey. bduz@gata.edu.tr
Gocmen
Selcuk
S
Secer
Halil Ibrahim
HI
Basal
Seref
S
Gönül
Engin
E
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
J Neurosurg. 1981 Apr;54(4):494-503
6259301
Neurosurg Focus. 2001 Jan 15;10(1):e5
16749757
J Neurosurg Spine. 2007 Mar;6(3):210-5
17355019
Acta Neurochir (Wien). 2000;142(10):1111-5
11129532
J Neurosurg. 2001 Apr;94(2 Suppl):205-9
11302621
J Neurosurg Spine. 2006 Feb;4(2):123-31
16506479
Childs Nerv Syst. 2007 Apr;23(4):371-5
17226037
J Bone Joint Surg Am. 1953 Jul;35-A(3):711-6
13069561
Childs Nerv Syst. 2000 Mar;16(3):150-4; discussion 155
10804050
Childs Brain. 1976;2(3):145-55
786565
J Bone Joint Surg Am. 2003 Nov;85(11):2089-92
14630835
Neurosurg Focus. 2007;23(2):E3
17961009