title: Detethering of a congenital tethered cord in adult patients: an outcome analysis.
abstract: BACKGROUND
  Tethered spinal cord syndrome (TCS) is characterized by attachment of the spinal cord down toward the tail end of the spine, comprising the danger of myelopathic symptoms. We retrospectively analyzed postoperative neurological outcome in adult patients with congenital TCS with special regard to the extent of resection of concomitant intraspinal lipomas.
  
  
  METHODS
  Medical records of 27 adult patients with congenital TCS (both with and without associated spinal lipomas) undergoing microsurgical detethering were systematically analyzed. Neurophysiological monitoring was available and feasible for all cases. Outcome parameters were preoperatively and postoperative neurological status; Wilcoxon rank test was used for statistical analysis.
  
  
  RESULTS
  In all patients, complete detethering was achieved. While urinary symptoms remained stable, all patients showed a non-significant tendency towards improvement of sensorimotor deficits. Both, patients with and without spinal lipoma experienced a significant postoperative amelioration of back pain. Patients with lipoma were found to suffer significantly less from radicular pain postoperatively (3/16). Furthermore, patients with a history of pain shorter than 1 year showed a significantly better chance for postoperative relief from back and radicular pain. The extent of lipoma resection had no significant impact on postoperative outcome.
  
  
  CONCLUSIONS
  Adult patients with symptomatic TCS profit from detethering, especially regarding relief of lower back and radicular pain. Complete removal of associated spinal lipomas does not seem to be mandatory for achieving a satisfying result.
authors.affiliation: Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany. alexander.romagna@med.uni-muenchen.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Romagna
authors.forename: Bogdana
authors.initials: B
authors.lastname: Suchorska
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwartz
authors.forename: Joerg-Christian
authors.initials: JC
authors.lastname: Tonn
authors.forename: Stefan
authors.initials: S
authors.lastname: Zausinger
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000150:complications; D005260:Female; D006801:Humans; D008067:Lipoma / Q000151:congenital / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009436:Neural Tube Defects / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult