Thursday, June 18, 2015

Tethered cord

Geyik M, Alptekin M, Erkutlu I, Geyik S, Erbas C, Pusat S, Kural C. Tethered cord syndrome in children: a single-center experience with 162 patients. Childs Nerv Syst. 2015 May 22. [Epub ahead of print]

Tethered cord syndrome (TCS) is not an uncommon clinical problem in children. The aim of this retrospective study is to document our experience on the surgical treatment of TCS in childhood.

The data of 162 children who underwent surgical treatment for TCS in a 15-year period were reviewed retrospectively. Their demographic, clinical, radiological, and surgical features were documented. They were divided into two groups as primary and secondary TCS, and the surgical technique for each group was demonstrated. Untethering the spinal cord and correction of the associated malformation were the standard surgical technique for each patient. The results of the treatment were summarized.
Among the 162 children, 101 (62.3 %) of them were female and 61 were male with a mean age of 62 months. Primary TCS was detected in 43 patients while secondary TCS was found in 119 (73.4 %) patients. Hypertrichosis was the most common physical finding while back pain was the common complaint. Lipoma, split cord malformation, dermal sinus tract, and myelomeningocele were the associated malformations for secondary TCS.
Children should be individualized for the treatment of TCS. Each patient must be evaluated neurologically and radiologically for the accurate diagnosis. Surgical untethering is the safe and effective method of treatment for children with TCS.

Primary TCS was detected in 43 patients while secondary TCS was found in 119 (73.4 %) patients. Among the patients with secondary TCS syndrome, lipoma was associated with lesion in 23 patients while SCM in 51 patients, dermal sinus tract in 18 patients, and previous operation for myelomeningocele and meningocele in 27 patients. Back pain was present in 86 patients in the preoperative period. Preoperative clinical findings were hypertrichosis in 57 patients, leg weakness in 29 patients, and urinary problems in 26 patients. Physical examination was normal in 97 patients. Back pain was improved in 53 (61.6 %) patients after surgery. Neurological improvement was observed in 5 (17.2%) patients while urological improvement was observed in 3 (11.5 %) patients.

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