Childs Nerv Syst 13:298–335, 1997, Schneider SJ, , Rosenthal AD, , Greenberg BM, & Danto J: A preliminary report on the use of laser-Doppler flowmetry during tethered spinal cord release. Controversy exists regarding the indications to operate on patients with a tethered spinal cord as well as the appropriate timing for surgical tethered cord release (TCR) , , . J Neurosurg 104:5 Suppl 309–313, 2006, Sureshkumar P, , Craig JC, , Roy LP, & Knight JF: Daytime urinary incontinence in primary school children: a population-based survey. Clinicians suspect tethered cord readily in toe walking children; however, the incidence of tethered cord in this population has not been established. There are apparently many patients with tethered cord who remain asymptomatic their entire life. On a larger scale, it is important to note that there is literature that supports the notion that clinical progression in patients with lipomyelomeningocele is predictable based on the anatomy of the lipoma2 and that surgery may not prevent this progression over the long run.8. The author evaluates existing clinical and scientific evidence relevant to this controversy. of 44 patients with long‑term follow‑up. 1C.). Tethered spinal cord is often linked to spina bifida. The controversy surrounding surgery for occult tethered cord was highlighted recently in the May, 2006 issue of the Journal of Neurosurgery: Pediatrics, which published several papers on the subject. J Neurosurg 54:494–503, 1981. However, some researchers believe that trauma alone is not enough to cause the disorder. J Neurosurg. Tethered cord syndrome, usually discovered in childhood, is a developmental abnormality impairing the longitudinal movement of the spinal cord that can be combined with various forms of spinal dysraphism. Although increased tension on the conus from a thickened or fibrous filum11 or asymmetric growth of the spine and spinal cord provides a plausible explanation for spinal cord dysfunction, plausibility does not equal causality. Pathophysiology of the tethered spinal cord in cats. There was a very small syrinx of the distal spinal cord, not well demonstrated on these images. Recently, surgery has been offered to children who have a normally positioned conus medullaris and no terminal filum abnormality visible on 1.5-tesla magnetic resonance images (referred to as minimal or occult tethered cord syndrome [TCS]). Especially the indications for and timing of surgical release have remained topics of discussion. May 22, 2014 at 7:24 am; Report; Hi Mei Mei, About a year ago, when my bladder problems started, almost 2 years ago, I went to see a Urologist who prescribed Flomax. Officially, once the patient has stopped growing, asymptomatic Tethered Cord Syndrome is usually not recommended for surgery, the recommended treatment is observation. J Neurosurg 104:5 Suppl 302–304, 2006, Steinbok P, , Garton HJ, & Gupta N: Occult tethered cord syndrome: a survey of practice patterns. tethered cord creates traction, or a pulling effect, and can lead to leg weakness and urinary and bowel problems. Leaving the subcutaneous lipoma as a biological graft (for subsequent elective removal by liposuction) or inserting a lumbar drain intraoperatively (impossible to do percutaneously postoperatively) are other unproven strategies to prevent CSF leak. Especially the indications for and timing of surgical release have remained topics of discussion. Controversy exists regarding proper indications for surgical lysis of the terminal filum in children with voiding dysfunction and tethered spinal cord. Tethered Cord Release Surgery. J Urol 144:426–429, 1990, McLone DG, & La Marca F: The tethered spinal cord: diagnosis, significance, and management. Warf et al. Treatment decision making is made difficult by the variety of lesions and clinical presentations comprised by this condition and the absence of high-quality clinical outcome data to provide guidance. Among these studies, it has been shown that symptomatic tethered cord will produce clinical deterioration with regard to bladder spasticity and orthopedic foot deformity if only treated symptomatically. Tethered Cord Syndrome . Other common scenarios include cases of scoliosis with what appears to be an idiopathic curve, in which the conus is reported as being low or “borderline low” at the inferior margin of L-2 with or without fat in the filum. 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