Perineal pain secondary to tethered cord syndrome: retrospective review of single institution experience.
OBJECTIVE
Tethered cord syndrome (TCS) encompasses a spectrum of neurological dysfunction related to excessive tension on the distal spinal cord resulting in anatomic deformation and metabolic disturbance. Symptoms typically manifest as back/leg pain, neurogenic bladder dysfunction, constipation, sphincter abnormalities, and scoliosis. To date, among the least well-described symptoms of TCS is pain or hypersensitivity in the perineal region. The authors reviewed their experience with spinal cord detethering to identify and further characterize those who present with perineal pain or hypersensitivity.


METHODS
Cases of spinal cord detethering at a single institution were retrospectively reviewed. Patients were initially identified by procedural codes. Cases were reviewed for presenting symptoms, specifically perineal pain or hypersensitivity. Magnetic resonance image (MRI) findings, clinical outcome, and length of follow-up were also noted.


RESULTS
Of the 491 patients identified, seven patients (1.4%) were identified as having preoperative perineal pain or hypersensitivity. All of these patients had complete resolution of perineal pain/hypersensitivity at the time of last follow-up. Furthermore, five (71%) of these patients experienced resolution of all initial symptoms.


CONCLUSIONS
Perineal pain or hypersensitivity can be an important symptom of spinal cord tethering. Spinal cord detethering may result in a good outcome and relief of perineal pain or hypersensitivity.
Division of Neurosurgery, Department of Surgery, University of Nebraska Medical Center, 982035 Nebraska Medical Center, Omaha, NE, 68198-2035, USA.
J Will
JW
Robbins
Division of Neurosurgery, Department of Surgery, University of Nebraska Medical Center, 982035 Nebraska Medical Center, Omaha, NE, 68198-2035, USA.
Paige A
PA
Lundy
Division of Neurosurgery, Department of Surgery, University of Nebraska Medical Center, 982035 Nebraska Medical Center, Omaha, NE, 68198-2035, USA. apgard@unmc.edu.
Andrew P
AP
Gard
Division of Neurosurgery, Department of Surgery, University of Nebraska Medical Center, 982035 Nebraska Medical Center, Omaha, NE, 68198-2035, USA.
Mark J
MJ
Puccioni
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009436:Neural Tube Defects / Q000150:complications* / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D010146:Pain / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
Pediatric; Perineal pain; Spinal dysraphism; Tethered cord syndrome