Introduction: Tethered cord syndrome is a common spinal problem seen in Pakistan because of high incidence of spinal dysraphism. It is a combination of signs of motor and sensory neuron dysfunction due to increased tension on the spinal cord. The treatment for TCS is primarily surgical.
Methods: Thirty-four consecutive patients treated surgically for “tethered cord syndrome” over a 3-three year period were followed prospectively.The main presenting complaints were back and leg pain, progressive lower limb and spinal deformity and neurological deficits. Untethering of the cord was achieved in majority of the patients, filum terminale was divided in over half of these patients. The mean post-operative follow up was 15 months in which we compared the surgical outcomes with MRI findings, tethering levels and symptoms.
Results: 85 % had tethering at L3-S2 level and 15 % had tethering at higher Level. Improvement of symptoms was seen in half of the patients with L1-S2 levels. Based on MRI findings, 83% of the patients who had thickened filum showed improvement, while 63, 57 and 44 % of the patients with diastematomyelia, lipoma and meningocele showed improvement respectively. Two third OF Patients with parapresis showed improvement post-operatively, while 25% remained static. In patients with paraplegia, only one third showed improvement. The overall surgical outcomes showed 59% of the patients had improvement, while 38% remained static and one patient worsened.
Conclusions: Tethering at dorsal spine does not improve outcome but make neurology static. Patients with paraplegia showed no improvement in neurology. Thickened filum terminale and diastematomyelia had the best outcome and should be considered for surgery. Our series suggests that untethering in patients with “tethered cord syndrome” improves or arrests the progression of neurological deterioration.
Patient Care: Selection of patients for surgery made simpler with this conclusion
Learning Objectives: By conclusion of this paper, the attendees should be able to choose patients with better surgical outcome than the others in Tethered cord syndrome