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Asghar Ali
Rizwan Ali
Gohar Ali


Tethered cord syndrome, Adults, Spinal dysraphism


Background and Aim: Tethered cord syndrome (TCS) encompasses a range of neurological, urological, and orthopedic symptoms and findings resulting from spinal cord malformations. Majority of cases are associated with spinal dysraphism. The clinical presentations vary depending on the individual's age and variation in underlying pathological condition with the most common manifestations encompassing pain, skin-related signs, orthopedic deformities, and neurological deficits. The objective of this study was to investigate the adult patients diagnosed with TCS.

Patients and Methods: This retrospective study was conducted on 50 TCS patients in the Department of Neurosurgery, Mardan Medical Complex, Mardan - Pakistan from March 2020 to April 2023.  Individuals aged >18 years diagnosed of tethered cord syndrome were enrolled. The study investigated the occurrence and manifestations of various types of spinal dysraphism, as well as the untreated late-presenting cases' natural progression.

Results: The overall mean age was 32.64±4.8 years with an age range 18 to 70 years. There were 16 (32%) male and 34 (68%) females. Back-Leg pain was the prevalent reason for presentation of tethered cord syndrome in n=30 (60%) cases followed by urological complaint n=10 (20%), skin abnormalities 4 (8.0%), Orthopedic abnormalities 3 (6.0%), Numbness-Contraction 2 (4.0%), and neck-arm pain 1 (2.0%). The incidence of spinal dysraphism associated with TCS such as lipomeningomyelocele, TCS secondary to myelomeningocele, dermal sinus, diastematomyelia, meningocele, and thick filum terminale was 16 (32%), 12 (24%), 8 (16%), 6 (12%), 5 (10%), and 3 (6%) respectively.

Conclusion: The present study found that TCS patients should be promptly shifted for the assessment and treatment shortly after diagnosis. This is crucial because without treatment, they are at risk of experiencing progressive neurological deficits.

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1. Wahyudana IN, Krisnawan GA. Tethered Cord Syndrome in Adulthood. Neurologico Spinale Medico Chirurgico. 2023 January 1;6(2):42-6.
2. Lin GZ, Xie JC, Chen XD, Yang J. Classification and microsurgical treatment of primary tethered cord syndrome in adults. Beijing da xue xue bao. Yi xue ban= Journal of Peking University. Health Sciences. 2023 March 1;55(4):641-5.
3. McVeigh LG, Anokwute MC, Chen S, Jea A. Spinal column shortening for tethered cord syndrome: a systematic review and individual patient data meta-analysis. Journal of Neurosurgery: Pediatrics. 2022 Mar 4;29(6):624-33.
4. Sofuoglu OE, Abdullah A, Emel E, Guler B. Management of tethered cord syndrome in adults: experience of 23 cases. Turk Neurosurg. 2017;27(2):226–36.
5. Gao J, Kong X, Li Z, Wang T, Li Y. Surgical treatment on adult tethered cord syndrome. A retrospective study. Medicine. 2017;96(32):e7808.
6. Seki T, Hida K, Yano S, Sasamori T, Hamauch S, Koyanagi I, Houkin K. Surgical outcome of children, and adolescents with tethered cord syndrome. Asian Spine J. 2016;10(5):940–4.
7. O'Connor KP, Smitherman AD, Milton CK, Palejwala AH, Lu VM, Johnston SE, et al. Surgical treatment of tethered cord syndrome in adults:A systematic review and meta-analysis. World Neurosurg 2020;137:e221–41.
8. Gao J, Kong X, Li Z, Wang T, Li Y. Surgical treatments on adult tethered cord syndrome:A retrospective study. Medicine (Baltimore) 2016;95:e5454.
9. Son HS, Kim JH. Urological presentations of adult primary tethered cord syndrome. Neurourol Urodyn 2020;39:633–41.
10. Elmesallamy W, AbdAlwanis A, Mohamed S. Tethered cord syndrome:Surgical outcome of 43 cases and review of literatures. Egypt J Neurosurg 2019;34:4–13.
11. Finger T, Aigner A, Depperich L, Schaumann A, Wolter S, Schulz M, et al. Secondary tethered cord syndrome in adult patients:Retethering rates, long-term clinical outcome, and the effect of intraoperative neuromonitoring. Acta Neurochir (Wien) 2020;162:2087–96.
12. Xu F, Wang X, Li L, Guan J, Jian F. Tethered cord syndrome caused by duplicated filum terminale in an adult with split cord malformation. World Neurosurgery. 2020 Nov 1;143:7-10.
13. Lee SH, Shin HI, Nam TK, Park YS, Kim DK, Kwon JT. Growth profile assessment of young adults with tethered cord syndrome: a retrospective cohort analysis of Korean conscription data. Child's Nervous System. 2021 Jun;37:1973-81.
14. Novik Y, Vassiliev D, Tomycz ND. Spinal cord stimulation in adult tethered cord syndrome: case report and review of the literature. World Neurosurgery. 2019 Feb 1;122:278-81.
15. O'Connor K.P. et al. Surgical treatment of tethered cord syndrome in adults: a systematic review and meta-analysis World Neurosurg (2020)
16. Karim A. Ahmed et al. Split cord malformation in adults: literature review and classification Clin Neurol Neurosurg (2020)
17. Tuite GF, Thompson DNP, Austin PF, Bauer SB. Evaluation and management of tethered cord syndrome in occult spinal dysraphism: recommendations from the international children's continence society. Neurourol Urodyn. 2018; 37: 890-903.
18. Sepulveda W, Wong AE, Sepulveda F, Alcalde JL, Devoto JC, Otayza F. Prenatal diagnosis of spina bifida: from intracranial translucency to intrauterine surgery. Childs Nerv Syst. 2017; 33: 1083-1099
19. Qudsieh SM, Barbarawi MM, Alkhataybeh RA, Amarin ZO, Barbarawi AM, Barbarawi MH, Jarrar SM, Jaradat AA, Alhourani M, Ghammaz O. Tethered Cord Syndrome and Split Cord Malformation: A Retrospective Review with Advanced Surgical Technique.
20. Jiang Q, Tao B, Gao G, et al.: Filum terminale: a comprehensive review with anatomical, pathological, and surgical considerations. World Neurosurg. 2022, 164:167-76. 10.1016/j.wneu.2022.04.098
21. Sun M, Tao B, Gao G, Wang H, Shang A: Determination of the normal conus medullaris level in term infants: the role of MRI in early infancy. J Neurosurg Pediatr. 2022, 29:100-5. 10.3171/2021.7.PEDS21284
22. Costa Almeida L, de Souza Figueiredo YJ, Pinheiro Zylberman A, Garção DC: Ascent of the conus medullaris in human foetuses: a systematic review and meta-analysis. Sci Rep. 2022, 12:12659. 10.1038/s41598-022- 15130-9.
23. Sung HJ, Lee HS: Dorsal midline cutaneous stigmata associated with occult spinal dysraphism in pediatric patients. Korean J Pediatr. 2019, 62:68-74. 10.3345/kjp.2018.06744.
24. Choi SJ, Yoon HM, Hwang JS, Suh CH, Jung AY, Cho YA, Lee JS: Incidence of occult spinal dysraphism among infants with cutaneous stigmata and proportion managed with neurosurgery: a systematic review and metaanalysis. JAMA Netw Open. 2020, 3:e207221. 10.1001/jamanetworkopen.2020.7221.
25. Day EL, Proctor MR, Scott RM: Surgical volume of simple tethered spinal cord releases: review of a large pediatric neurosurgical service experience. J Neurosurg Pediatr. 2020, 26:60-4. 10.3171/2020.2.PEDS19743
26. Vepakomma D, Kumar N, Alladi A: Tethered cord syndrome-role of early surgery . J Indian Assoc Pediatr Surg. 2019, 24:124-8. 10.4103/jiaps.JIAPS_49_18
27. Jia S, Wei X, Ma L, et al (2019) Maternal, paternal, and neonatal risk factors for neural tube defects: A systematic review and meta‐analysis. International Journal of Developmental Neuroscience 78:227– 235. https://doi.org/10.1016/j.ijdevneu.2019.09.006
28. AYDIN H, ARISOY R, KARAMAN A, et al (2016) Evaluation of maternal serum folate, vitamin B12, and homocysteine levels andfactor V Leiden, factor II g.20210G>A, and MTHFR variations in prenatallydiagnosed neural tube defects. Turk J Med Sci 46:489–494. https://doi.org/10.3906/sag1502-128
29. Li Z-X, Gao Z-L, Wang J-N, Guo Q-H (2016) Maternal Coffee Consumption During Pregnancy and Neural Tube Defects in Offspring: A Meta-Analysis. Fetal Pediatr Pathol 35:1–9. https://doi.org/10.3109/15513815.2015.1122121.
30. Fekete G, Bognár L, Novák L. Surgical treatment of tethered cord syndrome-comparing the results of surgeries with and without electrophysiological monitoring. Childs Nerv Syst. 2019;35(6):979-984.

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