title: History of the current understanding and management of tethered spinal cord.
abstract: An understanding of the underlying pathophysiology of tethered cord syndrome (TCS) and modern management strategies have only developed within the past few decades. Current understanding of this entity first began with the understanding and management of spina bifida; this later led to the gradual recognition of spina bifida occulta and the symptoms associated with tethering of the filum terminale. In the 17th century, Dutch anatomists provided the first descriptions and initiated surgical management efforts for spina bifida. In the 19th century, the term "spina bifida occulta" was coined and various presentations of spinal dysraphism were appreciated. The association of urinary, cutaneous, and skeletal abnormalities with spinal dysraphism was recognized in the 20th century. Early in the 20th century, some physicians began to suspect that traction on the conus medullaris caused myelodysplasia-related symptoms and that prophylactic surgical management could prevent the occurrence of clinical manifestations. It was not, however, until later in the 20th century that the term "tethered spinal cord" and the modern management of TCS were introduced. This gradual advancement in understanding at a time before the development of modern imaging modalities illustrates how, over the centuries, anatomists, pathologists, neurologists, and surgeons used clinical examination, a high level of suspicion, and interest in the subtle and overt clinical appearances of spinal dysraphism and TCS to advance understanding of pathophysiology, clinical appearance, and treatment of this entity. With the availability of modern imaging, spinal dysraphism can now be diagnosed and treated as early as the intrauterine stage.
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Sam
authors.initials: S
authors.lastname: Safavi-Abbasi
authors.affiliation: Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Mapstone
authors.affiliation: Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Archer
authors.affiliation: Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wilson
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Preul
mesh_terms: D005060:Europe; D049670:History, 17th Century; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008512:Medicine in the Arts; D009436:Neural Tube Defects / Q000266:history* / Q000628:therapy; D009656:North America
keywords: TCS = tethered cord syndrome; congenital; history of neurosurgery; spina bifida; spinal cord; tethered cord syndrome