Introduction: The tethered cord syndrome (TCS) is a stretch-induced functional disorder of the spinal cord with its caudal part anchored by an inelastic structure, resulting in characteristic symptoms and signs. Due to the variety of lesions and clinical presentations and the absence of high-quality clinical outcome data, the decision regarding treatment is difficult.
Methods: We reviewed 50 consecutive patients who were surgically treated for tethered cord syndrome at Liaquat National Hospital and Medical College, Karachi between the years 2010-2013. The follow up period of these patients were from 3 months to 36 months. The patients were assessed for power, gait, urinary and bowel control, and deformity using our own Karachi’s TCS Severity Scale for Clinical Assessment.
Results: Eighty five percent of the patients with thickened filum terminale improved. Sixty six percent of the patients with diastematomyelia, sixty percent with lipoma and forty six percent with myelomeningocele showed clinical improvement post-operatively. Sixty two percent of the patients who presented with paraperesis improved following surgery while thirty seven percent remained stable and only one patient had worsening. Back and leg pain improved in ninety three percent of patients and half of patients with urinary impairment improved.
Conclusions: Patients with diastematomyelia and thickened filum presenting with tethered cord syndrome had better outcome compared to patients with Myelomeningocele or meningocele.
Patient Care: My research will imply a new method to assess TCS patients pre and post operatively using the Karachi's TCS Scale.
Learning Objectives: By the conclusion of this session, participants should be able to
1. Know the different patterns of presentation of tethered cord in this part of the world.
2. Know the prevelance of TCS in this part of the world
3. Understand the management of different pathologies associated with TCS
4. Learn the our new scale "Karachi's TCS severity scale for clinical assessment"
5. Apply the Karachi's TCS severity scale for clinical assessment pre and post operatively to assess the outcome of the patient.