title: Orthopedic lesions in tethered cord syndrome: the importance of early diagnosis and treatment on patient outcome.
abstract: BACKGROUND
  Many of the patients with tethered cord syndrome (TCS) are admitted because of neurological symptoms, while some are admitted because of their orthopedic, urologic, anorectal, and dermatologic manifestations. Consequently, this study aimed to evaluate the importance of early diagnosis and treatment of tethered cord syndrome on patient outcome.
  
  
  METHODS
  Fourty-three patients who underwent surgery because of tethered cord syndrome from 2006 to 2010 were studied. Many of these cases were referred by orthopedic surgeons. All of the findings were recorded and follow up was done twice (1 and 3 years after surgery).
  
  
  RESULTS
  Thirty-seven patients were less than 7 years old and 6 were between 17 to 33 years old. According to clinical and neurological exams, satisfactory results were achieved in both groups. Those with early surgical intervention, especially in their early follow up assessment, had the best results. Seventeen cases were referred by an orthopedic surgeon because of manifestations such as leg weakness and numbness, leg pain and spasticity, pes cavus, claw toes, and leg or foot length discrepancy. Cerebrospinal fluid leakage occurred in 3 cases after surgery and 1 showed pseudomeningocele formation.
  
  
  CONCLUSIONS
  After one year of follow up, initially the results of the treatment were better in early operated cases, but in later follow up assessment (after 3 years) the results were almost the same in both of the groups.
authors.affiliation: Mohammad Gharedaghi MD, Orthopedic Research Center, Department of Orthopedic Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Gharedaghi
authors.affiliation: Mohammad Gharedaghi MD, Orthopedic Research Center, Department of Orthopedic Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Fariborz
authors.initials: F
authors.lastname: Samini
authors.affiliation: Mohammad Gharedaghi MD, Orthopedic Research Center, Department of Orthopedic Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Hosein
authors.initials: H
authors.lastname: Mashhadinejad
authors.affiliation: Mohammad Gharedaghi MD, Orthopedic Research Center, Department of Orthopedic Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Khajavi
authors.affiliation: Mohammad Gharedaghi MD, Orthopedic Research Center, Department of Orthopedic Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Samini
keywords: Orthopedic lesionsn; Tethered cord syndrome; Tight filum terminale