Sattar M Hashim, Shahid Ahmed, Rashid Jooma.
Surgical management of tethered spinal cord syndrome: an analysis of 248 cases.
J Surg Pak Jan ;12(4):149-54.

Objective: To define the presentation, exact mechanism, and surgical treatment of tethered spinal cord syndrome (TSCS) with particular emphasis on timing of surgery and outcome. Study Design: Analytical study. Place & Duration of Study: Department of Neurosurgery, Jinnah Postgraduate Medical Centre (JPMC) from January 2001 to December 2006. Patients & Methods: A total of 248 patients were included in this study who presented for treatment between 6 days and 32 years of age with a median age of 6.5 months. One hundred patients presented before the age of 6 months. Most common complaint was cosmetic defect/swelling on their back (n 156). Sixty-six patients had urinary incontinence, 35 patients had deformed or weak leg and 15 had ulcers on their feet. Results: There were 172 female and 76 male patients. The most frequent tethering lesions were lipoma in 156, un-repaired myelomeningocele in 15, post repair myelomeningocele in 18, hypertrichosis in 17, spilt cord malformation in 10, tight filum terminate in 15, dermal sinus or dimple with stalk in 12, sacral agenesis in 3 and appendage with stalk in 2 patients. Out of 100 operated before 6 months of age, only 2 patients returned back with incontinence of urine and required un-tethering again. Improvement of symptoms at 6 months after surgery was noted in 78% patients operated after 6 months of age. Stabilization of symptoms was achieved in 8 patients having adult age at time of surgery. Minimum follow up was two years in 210 and maximum of 4 years in 17 surgically treated patients with stable neurological condition. Conclusions: Best outcome is achieved after complete un-tethering of cord at younger age. To avoid irreversible neurological damage, early diagnosis and repair is recommended. The symptoms most resistant to surgical treatment were orthopedic abnormalities where as bladder dysfunction and motor weaknesses were amendable to surgical therapy.

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