title: Pathophysiology of adult tethered cord syndrome: review of the literature.
abstract: OBJECTIVE
  Tethering of the spinal cord has been a recognized cause of neurological symptoms in pediatric patients and is increasingly being recognized as a cause of symptoms in adults as well. The pathophysiology surrounding spinal cord tethering has begun to be understood in the pediatric population but is still unclear in adult patients.
  
  
  METHODS
  Using a PubMed database literature search, the authors reviewed the pathology and pathophysiology surrounding the tethered spinal cord, focusing particularly on the pathophysiology of adult tethered cord syndrome (TCS).
  
  
  RESULTS
  Experimental data obtained in pediatric patients at surgery and in animal models indicate that spinal cord tethering causes a reduction in spinal cord blood flow and dysfunction of neuronal mitochondrial terminal oxidase. Retrospective analyses of patients undergoing surgery for adult TCS show that many adults developed symptoms following an event that could stretch the spinal cord, while others did not. Many patients also were found to have structural lesions in addition to a tethered spinal cord at diagnosis.
  
  
  CONCLUSIONS
  Both adult and pediatric TCSs are likely the result of a relative lack of blood flow to the spinal cord, causing dysfunction in mitochondrial oxidative phosphorylation. The likely reason the syndrome present later and differently in adults is that a secondary threshold of tension or a cumulative effect of repetitive, transient tension is placed on the cord before symptoms are recognized.
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109-5338, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Stetler
authors.forename: Paul
authors.initials: P
authors.lastname: Park
authors.forename: Stephen
authors.initials: S
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D000367:Age Factors; D002648:Child; D006801:Humans; D009436:Neural Tube Defects / Q000503:physiopathology* / Q000601:surgery; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome