Tethered Cord Syndrome Prognostic Factors and Surgical outcome

Abstract

Tethered spinal cord is one of the challenging problems facing the neurosurgeon. Forty four patients with the diagnosis of tethered cord syndrome were reviewed. There were 27 females and 17 males with a mean age of 5.9 years (range 1 month-36 years). The main symptoms were: urological problems in 24 patients (54.5%), weakness in 21 patients(47.7%), leg and spine deformity in 15 patients (34.1%), lumbosacral mass in 15 patients (34.1%), stool incontinence and constipation in 17 patients (38.6%), back and leg pain in 10 patients (22.9%). The main physical finding were: cutaneous stigmata in 29 patients (65.9%), motor weakness in the lower limbs in 21 patients (47.7%), spine deformity in 9 patients (20.5%), and sensory impairment in the lower limbs or perineal area in 15 patients (34.1%). The main radiological investigation were MRI which was done in 41 patients. The main radiological finding was a low conus medullaris below L2 level which was found in 38 patients (86.4%). The underlying tethering pathology includes lipomyelomeningocele in 10 patients (22.7%), thick filum terminale in 8 patients (18.2%), retethering to previous site of myelomeningocele repair in 6 patients (13.6%), diastemnatomyelia in 5 patients (11.4%), and other causes in 15 patients (34.1%). The total number of operated patients were 37 patients (84.1%), the remaining 7 patients (15.9%) refused surgery. The post operative surgical outcome revealed improvement in 19 patients (51.3%), 17 patients (45.9%) remained stable with no further deterioration, and only one patient continue to deteriorate. In the non operated group, 3 patients (42.8%) deteriorated. A review of the literature was carried out, and a correlation between different factors and the post operative condition of the patients were performed. It is concluded that the prognostic factors that are associated with a more favorable post operative outcome may includes: 1) short duration of symptoms (less than or equal six months). 2) presentation with back pain carries the best prognosis, motor weakness and secondary incontinence carries a less favorable prognosis, and primary incontinence as well as duple incontinence carries the worst prognosis. 3) Tethering pathologies such as thick filum terminale and diastematomyelia carries a favorable prognosis, while retethering to previous site of myelomeningocele repair carries the worst prognosis. 4) A conus medullaris above L2 level carries a better prognosis than when it is below L2 level.