In one of the rst recorded . 3 MeSH WebConclusions: Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. [6] In 1981, Yamada et al[7] found in animal studies that the role of mitochondrial metabolism was reduced in the termination of spinal cord, the greater the tension, the longer the time, and the more serious the nervous dysfunction was. Careers. Abstract. According to Hoffman grading system, the neurologic symptoms were improved in 22 patients (27%), stabilized in 60 patients (73%). Tethered cord syndromea study of the short-term effects of surgical detethering on markers of neuronal injury and electrophysiologic parameters. Yamada S, Lonser R R. Adult tethered cord syndrome. The surgical procedure performed at L1 is described below. In 1891, Jones [14] described what probably is Adult tethered cord syndrome (ATCS) is a rare entity that usually presents with multiple neurological symptoms, including lower extremity pain, backache, lower extremity muscle weakness, and bowel/bladder disturbances. The nurse will help schedule the COVID-19 PCR test. Garceau theorized that tension on the . Back pain: 14% better; 14% worse; leg pain: 11% better; 11% worse, Back pain: 78% better; 3% worse; leg pain: 83% better; 7% worse, Back pain: 77% better; leg pain: 47% better, 2% extradural hematoma/paraparesis; 5% revision CSF; 2% permanent neurologic worsening, 3% neurologic deterioration; 3% reoperation. Fixing Tethered Cords in Children vs. Urologic dysfunction subjectively improved in 36% of the patients with that complaint. The attached tissue limits the movement of the spinal cord within the spinal column and causes an abnormal stretching of the spinal cord and impairment of blood flow to the nerve tissue. A tethered cord release reduces or removes the . On Oct. 18, 2017, 10-month-old Eva was taken to an operating room at Children's Hospital of Philadelphia, where Dr. Chen performed surgery to free Eva's spinal cord, and Jesse Taylor, MD, Chief of the Division of Plastic, Reconstructive and Oral Surgery, removed two of the lipomas. The care team will review your childs symptoms and how tethered cord syndrome is affecting their quality of life. 1A and B). Then, temporary rods were fixed in place for column stability while we performed the osteotomy. 2020 Feb;41(2):249-256. doi: 10.1007/s10072-019-04056-2. This calls for a wider recognition of the fact that tethered cord syndrome can present in adulthood also. Controversy persists regarding surgery in asymptomatic adults with TCS. J Neurosurg. Many recent reports of TCS in adult patients have grouped retethering patients with newly diagnosed ones without separately analyzing each entity and outcome. Treatment of posttraumatic syringomyelia. If they do experience a headache, your child will lay back down flat. Patients and methods Adult and children patients with tethered cord syndrome subjected to microscopic surgeries for release of cord and nerves . Untethering (tethered cord release) is the gold standard treatment for TCS. 19-42. . [3] Deformity of spinal cord, local tumor compression, scar adhesion, stubby filum terminale, can cause spinal cord fixed to the lesion site, so that the spinal cord cannot move up normally, which is the basis contributing to the incidence of TCS. From a surgical perspective, it is only necessary to remove the bony or . Physicians: To refer a patient, call 410-955-7337. Problems with movement. In addition and preoperatively, there were 68 cases (83%) of varying degrees of pain in the lumbosacral portion and lower extremity, 58 cases (71%) of motor dysfunction of the lower extremity, 44 cases (54%) with abnormal sensation, and 50 cases (61%) of defecation dysfunction. . official website and that any information you provide is encrypted Before Following a tethered cord release surgery, children are typically discharged in 1-2 days after surgery. doi: 10.3171/foc.2001.10.1.8. This allows the covering of the spinal cord to seal so Surgery is the only treatment for tethered cord. government site. Mitsuhiro Kamiya, none collected, please refer to our Privacy Policy. The Authors. Stretching and tension, especially in a growing child, can cause neurologic damage. Surgery may also restore some function or However, untethering carries risks of spinal cord injury and re-tethering. Given radiographic findings of tethered cord syndrome and clinical symptoms of pain, UTIs, urinary retention requiring catheterization, and constipation, it was recommended that the patient undergo untethering of the spinal cord via sectioning of the fatty filum terminale. 3. A tethered cord may go undiagnosed until adulthood when sometimes complex and severe symptoms come on slowly over time. Tethered cord release surgery has risks including permanent neurological changes such as of sensation and further lower extremity weakness, change in gait and at times reversible loss of the ability to ambulate. Tokumi Kanemura, none Going from horizontal to vertical felt like being hit in the back of the head with a baseball bat. In children surgery prevents further neurological deterioration. JG, XK, and ZL have contributed equally to the article. FOIA Gao, Jun MD, PhD; Kong, Xiangyi MD; Li, Zhimin MD; Wang, Tianyu MD; Li, Yongning MD, aDepartment of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China. Based on this small retrospective case series, SSO appears to provide clinical improvement at least comparable to that of the untethering procedure, especially in more challenging cases (complex malformations or revision surgery). Tethered cord syndrome is a stretch-induced functional disorder associated with the fixation (tethering) effect of inelastic tissue on the caudal spinal cord, limiting its movement. Tethered cord syndrome: an updated review. Through the follow-up of 56 cases of adult TCS patients, Httmann et al[9] found that the pain relief rate was 86%, which was the most obvious symptoms that alleviated, remission rate of the lower limb spasticity was 7l%, and the remission rate of bladder dysfunction and feeling movement dysfunction was 44% and 35%, respectively. The mean duration of follow-up was 4.73.5 years (range, 2.0 to 15.5 years). A T12 to L1 diskectomy and L1 upper one-third vertebral body resection were performed thereafter. Complications include infection, bleeding, and damage to the spinal cord or myelomeningocele, which may result in decreased muscle strength or bladder or bowel function. We conducted a retrospective multicenter study. We talked about bracing but it had to be delayed because a follow up MRI showed a tethered cord that needed surgery. But previous investigation estimated that no more than 40% of dermoid cyst could be completely removed. All patients were followed up, no death occurred. Shooting pain in the legs. For instance, if a traditional fusion surgery is performed, recovery time will be longer and thus differ from a less invasive, motion preserving spine procedure. In adults, surgery to free (detether) the spinal cord can reduce the size and further development of cysts in the cord. Terminal syringohydromyelia and occult spinal dysraphism. modify the keyword list to augment your search. Federal government websites often end in .gov or .mil. 19. HOB, positioning, activity, bathing: The patient is kept flat on bed rest for 3 days to allow for dural healing and to put as little CSF pressure on the dura as possible during this time. Tethered cord occurs when the spinal cord is attached to tissues around the spine, most commonly at the base of the spine. During this call, the nurse will help decide which type of anesthesia is best for your child and if your child may have any risks with anesthesia. Symptoms of Tethered Spinal Cord Syndrome in Teens and Adults. 5 Therefore, he believed that the dysfunction of the nerve cells in the spinal cord might be caused by the impairment of mitochondrial oxidative metabolism. Pediatric pathology all grown up - An interesting case of adult tethered spinal cord. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 3332016010; grant recipient: XK) and Peking Union Medical College Graduate Student Innovation Fund (2015) (project no. Repeated bladder infections. With a recommendation for surgery this figure rose to 47% within 5 years. Abnormal tissue, growth, tightening, or thickening of tissue can make it hard to move the spinal cord. where is winter the dolphin buried; forest management plan maryland Perioperative complications are another concern in adult TCS. WebRecurrent tethered cord syndrome (TCS) can lead to significant progressive disability in adults. Rajpal S, Tubbs RS, George T, Oakes WJ, Fuchs HE, Hadley MN, Iskandar BJ. This causes extra stress on the nerves and can cause a range of symptoms known as tethered cord syndrome. The General Hospital Corporation. [16] On the whole, patients with filar TCS had the lightest symptoms, corresponding surgery was relatively easy, and prognosis in the follow-up period was relatively better after removing filum terminale. 4 A retrospective analysis of 82 adult patients with TCS treated by surgery was conducted between March 2005 and December 2015 in Peking Union Medical College Hospital. 13 Preoperative shorter duration of symptoms is associated with favorable clinical outcome because the pathophysiology of TCS is associated with impaired oxidative metabolism in the affected spinal cord.7 You are here: Home / Uncategorized / tethered spinal cord constipation. Neurophysiologic intraoperative monitoring is when doctors place electrodes (wires with a sticker on one end) on your childs head, arms and legs. The authors reviewed their institutional experience with the surgical management of adult TCS to assess the time course of symptomatic improvement, and to . Tremors or spasms in the leg muscles. FOIA Untethering surgery was performed as a first procedure at our institution, and a massive arachnoidal scar and adhesion were found intraoperatively. HHS Vulnerability Disclosure, Help The population consisted of 12 men and 22 women, ranging in age from 18 to 70 years (mean 34 years). Tethered cord syndrome treatment. J Neurosurg Spine. 8. 9 11 The severity of the condition and the associated signs and symptoms vary from person to person. Tethered cord syndrome (TCS) refers to a series of neurological dysfunction caused by the retraction of the conus medullaris related to a variety of reasons, which is manifested by both lower extremities orbicularis weakness, sensory abnormalities, defecation dysfunction, and so on.[1]. Kokubun S, Ozawa H, Aizawa T, Ly N M, Tanaka Y. Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. This study compared clinical outcomes and perioperative complications resulting from untethering and SSO surgery performed on patients with adult TCS. The average length of spine shortening was 23.3 mm. http://creativecommons.org/licenses/by/4.0, Received in revised form October 19, 2016. Milano JB, Barcelos ACES, Onishi FJ, Daniel JW, Botelho RV, Dantas FR, Neto ER, de Freitas Bertolini E, Mudo ML, Brock RS, de Oliveira RS, Joaquim AF. This is not associated with spina bifida, but may occur in patients with Chiari malformation. My headaches began as intolerance to light and sound. A tethered spinal cord occurs when the inelastic tissue on the caudal spinal cord is abnormally attached to a structure instead of free floating. Spina Bifida: Pathogenesis, Mechanisms, and Genes in Mice and Humans. Fatty Filum Terminale. Epub 2012 Jul 13. This keeps the spinal cord from moving freely. [7] Significantly different from children with TCS, there was also the existence of incentives in adult patients with TCS, such as hip hyperflexion due to high falling injury, lithotomy position delivery, long-time sitting causing over stretching of the spinal cord, all of which might evoke the development of TCS.[8]. The neurological surgeon makes an incision in the lower back to expose the site where the spinal cord is pinned, then frees it by . The patient with tight terminal filum underwent untethering surgery. Conclusions: [4] In 1953, Garceau described the filum terminal syndrome, suspected that the tensive filum terminal pulled the spinal cord might cause defecation dysfunction and other symptoms. Bone chips from the excised laminae and spinous processes were also placed over the T12 and L1 laminae for posterior fusion. 2018 Mar;97(11):e0111. 11 Miyakoshi et al reported that all of the neurologic symptoms in the subjects of one of their studies were relieved without complications after SSO,10 and it was hoped on the basis of that study that SSO would become a preferable approach for TCS in adults, but the number of patients in their study was small (n=3). 2014; 192:221-7. . Yamada S, Lonser RR. However, some neurological and motor impairments may not be fully correctable. Hiroki Matsui, none The position in which it comes to rest in an adult (L1 or L2) is caused by the growth of the individual. Iskandar BJ, Oakes WJ, McLaughlin C, Osumi AK, Tien RD. Moreover, complications, such as cerebrospinal fluid (CSF) leakage and neurologic deterioration, have been frequently reported.1 12 Although the majority of affected patients with TCS are children and infants, several studies have shown that TCS also occurs in adults.1 Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis. Let us help you navigate your in-person or virtual visit to Mass General. However, The laminae and transverse processes of the vertebrae at T12 and L2 were resected, and the pedicle screws were placed bilaterally at these vertebrae. A hairy patch overlying the spine in any area is almost always associated with an underlying splitting of the spinal cord by a band of fibrous tissue or bone (a diastematomyelia). 17. All of the included 82 cases of patients received preoperative enhanced magnetic resonance imaging (MRI) examination, and there were several characteristics listed as follows: thickened filum terminale in a diameter of >2 mm; elongated, tapering, and low position of the coni medullaris, the coni medullaris located below the plane of vertebral body (L2) was considered to be low position of the coni medullaris; coni medullaris or the filum terminale attached closely to the posterior wall of the thecal sac, in a relatively straight shape; a large subarachnoid space was existed in the sacral canal; possible existence of occupying lesions adhered to the coni medullaris or the cauda equina, such as lipoma, dermoid cyst, and epidermoid cyst; potential existence of myelomeningocele or changes after prosthesis (Fig. Of the 2515 patients, 85 adults with a tethered cord syndrome formed the basis of this study. This causes stretching of the spinal cord as your child grows, leading to extra stress on nerves. Epub 2019 Oct 9. Duraplasty using substitute materials was performed at the close of surgery. Tethered cord syndrome in adults: experience of 56 patients. This handout is intended to provide health information so that you can be better informed. Tethered cord, also called tethered spinal cord syndrome, occurs when the spinal cord abnormally attaches to tissue inside the spinal canal, usually at the base of the spine. Although it was difficult to compare clinical outcomes due to the small numbers of patients and heterogeneity, SSO might be preferable for improving the symptoms in adult TCS after considering these baseline differences. WebPatients were examined by the same neurologist in a standardized fashion before and after surgery, and most were followed for at least 2 years postoperatively. 7 Tethered cord means that the spinal cord movement is limited within the spinal column due to abnormal tissue attachments. A retrospective analysis of 82 adult patients (17 male cases, 82% and 24 female cases, 59%) with TCS treated by surgery was conducted between March, 2005 and December, 2015, with an average age of 31.6 years and average disease course of 6.7 years. Clipboard, Search History, and several other advanced features are temporarily unavailable. Disclaimer. This delayed presentation of symptoms is related to the degree of strain placed on the spinal cord over time and may be exacerbated during sports or pregnancy, or may be due to narrowing . Six hospitals in our spine group were included. Throughout her time in high school, she had frequent . Tethered cord, also called tethered spinal cord syndrome, occurs when the spinal cord has abnormal attachments inside the spinal canal, usually at the base of the spine. You will have many questions about the disorder, and we are here to answer them. Among them, lipoma-oriented TCS was found in 10 cases of patients, of which including 2 cases showing symptoms improvement, 8 cases showing symptom stabilization, no case got worse. Httmann S, Krauss J, Collmann H, et al. Asian J Neurosurg. After exposing the dura mater spinalis, it was cut from the normal anatomical structure to the lesion. Long-term results showed a good prognosis in patients in whom first-time (that is, nonrevision) surgery achieved successful untethering, with a 10-year rate of neurological stabilization in 89% of Group A and a 10-year rate of neurological stabilization in 81% of Group B patients. We report a 63-year-old man with sudden-onset severe right chest and upper back pain, followed by . Prompt surgical treatment is often necessary to avoid permanent sequelae. WebThe clinical recurrence rate in all conservatively treated patients was 21% after 10 years. Pelissou-Guyotat I, Sindou M, Pialat J, Goutelle A. Solmaz I, Izci Y, Albayrak B, Cetinalp E, Kural C, Sengul G, Gocmez C, Pusat S, Tuzun Y. For most children who have tethered cord surgery, their symptoms do not progress or get worse. However, to use this type of procedure for spinal cord tethering is new and extremely rare, says Theodore . sharing sensitive information, make sure youre on a federal Iskandar B J, Fulmer B B, Hadley M N, Oakes W J. Congenital tethered spinal cord syndrome in adults. Diagnosis: Adult tethered cord is 15 Meanwhile, a history of prior surgery and complex preoperative categories of tethering lesions are also risk factors for worse clinical outcomes.7 11. When surgeons operate around the spinal cord, the area where the CSF lies is opened so they can untether the spinal cord. Epub 2015 Nov 26. First, it was a retrospective review of a small number of patients, due to the fact that the number of adult patients with TCS is relatively low, so securing a large number of patients for the study (especially patients with SSO) was difficult even though the study was a multicenter one. Because neurological deficits are generally irreversible, early surgery is recommended. Chapman P H. Congenital intraspinal lipomas: anatomic considerations and surgical treatment. government site. Recovery from the surgery is one to two weeks of . Epub 2018 Mar 8. Shukla M, Sardhara J, Sahu RN, Sharma P, Behari S, Jaiswal AK, Srivastava AK, Mehrotra A, Das KK, Bhaisora KS. In our study, in patients with severe Hoffman grading and without satisfied remission of symptoms, there were tendencies of longer medical history, more complications, and complicated symptoms; and for patients with relatively short medical history, Hoffman grading was shown to be mild and postoperative symptoms were improved obviously, which were similar with the above conclusions. Another common complication following this surgery is a cerebrospinal fluid (CSF, or the fluid that surrounds the spine) leak outside of its normal circulation. For larger cysts, it is not possible to force the free capsule wall directly, because the cone and the cauda equina are in a high tension state, and any tiny stretching is likely to cause further damage. WebAdult Tethered Cord Release - cns.org Open Access The Nexus online library is your free comprehensive resource for neurosurgical cases and approaches. This can lead to infection if the incision is on the low back. Recovery 9 WebIntroduction. WebA tethered spinal cord occurs when the spinal cord is attached to tissue around the spine, most commonly at the base of the spine. This abnormal fixation limits or prohibits movement of the cord within the spinal column. If no imaging has been done, your child may need a magnetic resonance imaging (MRI) test of their spine before the appointment. PMC Improvement in back pain and leg pain or numbness usually happens first, and bladder and bowel improvement happen last. WebFollowing a tethered cord release surgery, children are typically discharged in 1-2 days after surgery. 16. Nineteen (86%) of 22 employed patients returned to work after surgery. Because neurological deficits are generally irreversible, early surgery is recommended. Besides, there was no deteriorated case. An adult tethered cord syndrome has also been described. 13. HHS Vulnerability Disclosure, Help Web Spinal cord tethering may be either primary or secondary. OBJECTIVE Tethered cord syndrome (TCS) has been well described in pediatric patients. official website and that any information you provide is encrypted The authors reviewed their experience of newly diagnosed adult TCS patients to identify and explore TCS misdiagnosis, recognition, subtype pathology . 7 Patient age ranged from 19 to 75 years. Murata Y, Kanaya K, Wada H, et al. The authors studied the hospital records of 34 consecutive patients who presented in adulthood with tethered cord syndrome and conducted follow-up phone interviews with 28 of them. In Group A, 20 of 43 patients underwent surgery, whereas in Group B 23 of 42 patients underwent surgery. Copyright 2007-2023. At surgery, the spinal cord was freed from its attachments to the dura, and the symptoms resolved [13]. Careers. Equipment. He presented with symptoms of lower back pain and legs pain. A. An umbilical hernia repair is a relatively routine surgery and takes about 20 to 30 minutes. It is not a substitute for medical advice and should not be used to treatment of any medical conditions. Phi J H, Lee D Y, Jahng T A, Chung C K, Kim H J. Tethered cord syndrome in adulthood: reconsidering the prognosis. After a mean clinical follow-up period of 4 years, significant improvement occurred in 22 of 27 patients presenting with pain, 13 of 27 patients with motor or sensory dysfunction, and 11 of 18 patients with bowel and bladder disturbance. In some children who have tethered cord syndrome, they may lose control of their bladder or bowels. Back and leg pain improved in 50 and 63% of patients, respectively. Analysis was performed according to Hoffman grading system. (C) Postoperative lateral radiograph 3 years after surgery shows complete bone union and significant spine shortening. Clinical features at presentation are summarized in Table 1. [2] The tumor compression of the cone and the tail is one of the main causes for the tethered cord. For patients combined with subcutaneous giant lipoma in the lumbosacral region, the subcutaneous tumor was removed, and the drainage tube was placed into the left empty cavity, followed by pressurized dressing and vacuum aspiration. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Tethered Cord Syndrome (TCS) is a broad term that encompasses both congenital (primary) and acquired (secondary) pathologies that anchor, elongate and tension the spinal cord[1] The spinal cord fixation produces mechanical stretch, distortion, and ischemia with daily activities, growth, and development[2] This prevents the spinal cord from freely moving, which then increases . Published by Wolters Kluwer Health, Inc. In the patients who had undergone myelomeningocele repair during infancy or previous untethering surgery, meticulous dissection was required to ensure complete release of the spinal cord because of extensive arachnoidal adhesions. The records of 22 patients ranging from 4 days to 10 years old (mean 2.7 For more information about these cookies and the data Surg Neurol Int. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Tethering or scarring of the spinal cord has been suggested as a pathophysiological cause for the formation of a syrinx or cyst in the spinal cord. In contrast, sensory deficits were less likely to improve; numbness and paresthesias remained unchanged in 55% of the patients. Tethered cord syndrome in childhood: special emphasis on the surgical technique and review of the literature with our experience. A total of 32 consecutive adult patients underwent untethering surgery for secondary tethered cord syndrome in our department from January 2008 until December 2018. Treatment helps patients with tethered spinal cord syndrome have a normal life expectancy. Features of the condition may include foot and spinal abnormalities; weakness in the legs; loss of sensation (feeling) in the lower limbs; lower back pain; scoliosis; and urinary incontinence. J Neurosurg. Pang D, Wilberger J E Jr. Tethered cord syndrome in adults. These patients included those who had either tight terminal filum or secondary lesions that restricted the movement of the caudal spinal cord. Bookshelf This abnormal attachment is associated with progressive stretching and increased tension of the spinal cord as a child ages, potentially resulting in a variety of . Red flags that might lead a doctor to suspect tethered cord include any of its symptoms (although the same symptoms can be caused by a number of other spinal cord conditions); a previous diagnosis of a congenital spinal malformation; a history of cancer, infection, spine surgery; or spinal cord injury. Tethering can happen before or after birth in children and adults; and most often occurs in the lower (lumbar) level of the spine. Of 40 cases without occupying lesions of TCS, the symptoms were improved in 14 cases and stabilized in 26 cases, there was no deteriorated case. In the adult population, many patients receive inadequate care unless they are seen at a multidisciplinary clinic. 6 The purpose of this study was to compare the clinical outcomes of the two procedures for TCS in adults. Objective To evaluate the surgical treatment of tethered cord syndrome (TCS), a prospective analysis of 43 patients operated at Neurosurgery Department Zagazig University hospitals from May 2013 to January 2017 with 1 year follow-up had been done. Object: The mean estimated blood loss during surgery (300 ml in the open group vs 167 ml in the mini-open group, p = 0.313) and the mean length of stay (7 days in the open group vs 6.3 days in the mini-open group, p = 0.718) were similar between the 2 groups. Next, the T12 and L2 vertebrae were compressed gradually by using a pedicle screwrod construct with somatosensory-evoked potentials and motor-evoked potentials monitoring. No patients showed worsening of foot deformities and scoliosis. Institutional review board approval was obtained for medical records review. Lee G Y, Paradiso G, Tator C H, Gentili F, Massicotte E M, Fehlings M G. Surgical management of tethered cord syndrome in adults: indications, techniques, and long-term outcomes in 60 patients. There is very little out there on tethered cord in adults. 12 Treatment of TCS in adults is challenging because these malformations are rare, and adults may present with degenerative changes.9 Moreover, many adults with TCS have undergone previous surgery for myelomeningocele repair or untethering in childhood, which further complicates treatment.7, Untethering surgery has been commonly performed in the management of TCS in adults and children.7 However, neurologic recovery with regard to pain and neurologic deficit shows great variation, with improvement rates ranging from 0 to 100%.1 After identification of the terminal filum, we confirmed electromyography activity on bipolar stimulation before clip ligation and definitive sectioning. Twenty-eight patients remained in stable clinical condition. Symptoms may include back pain that radiates to the legs, hips, and the genital The https:// ensures that you are connecting to the 6 There were 4 cases of patients with grade 0 by preoperative Hoffman grading, 20 cases with grade 1, 28 cases with grade 3, 18 cases with grade 4, 10 cases with grade 5, and remaining 2 cases with grade 6. 11 Klekamp J. Tethered cord syndrome in adults. The effect of tethered cord release on coronal spinal balance in tight filum terminale. A nurse will call you for your childs anesthesia screening 1-2 days before their scheduled surgical date. In this study, we evaluated the feasibility of BCR monitoring during untethering surgery in infants and children to predict postoperative urinary and bowel dysfunction. (A) A 37-year-old male patient with a lumbar spinal lipoma at L3/L4 level. WebWhen a portion of the spinal cord becomes attached to lesions within the spinal column, excess strain can cause signs and symptoms such as pain, motor deficits, sensory deficits, bladder dysfunction, and bowel dysfunction. Overall, it remains unclear which procedure is preferable for TCS in adults: untethering surgery or SSO. The tethered spinal cord: its protean manifestations, diagnosis and surgical correction.

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