Tethered Cord Syndrome in Adulthood: Reconsidering the Prognosis.

Phi, Ji Hoon; Lee, Dong Yeob; Jahng, Tae Ahn; Chung, Chun Kee; Kim, Hyun Jib

Original Article

Journal of Korean Neurosurgical Society 2004;36(2): 114-119.

Ji Hoon Phi, Dong Yeob Lee, Tae Ahn Jahng, Chun Kee Chung, Hyun Jib Kim

Department of Neurosurgery, Clinical Research Institute, Seoul National University College of Medicine, Seoul, Korea. chungc@snu.ac.kr

ABSTRACT

OBJECTIVE
The surgical outcome of tethered cord syndrome(TCS) in adulthood has been known to be excellent. However, some patient seems to take worse clinical course despite the surgical intervention. The purpose of this study is to present the clinical characteristics of adulthood TCS and to analyze the surgical outcomes. METHODS: We retrospectively reviewed the medial records and radiological data of the 16 adult patients who was diagnosed as TCS and received detethering operation. After mean follow-up period of 43 months, neurological symptom and signs as well as the functional scores were taken for comparison with the preoperative status. RESULTS: Voiding difficulty was the most common symptoms. Delay of the proper diagnosis was notable with a mean interval of 14.4 years. Lipomyelomeningocele, especially of complex type was the most common etiologic lesion. After operation, only three patients got improvement of their preexisting symptoms. Two patients underwent progressive neurological dysfunction despite detethering. Only one patient showed improvement in functional scores. Three patients even received multiple operations. But the results were poor with no symptomatic improvement. CONCLUSION: Detethering halted the progression of neurological deficit in the majority of cases, but both symptomatic and functional improvement was disappointing. Long symptomatic period with delayed diagnosis, dominant bladder dysfunction and complex lipomyelomeningocele may influence negatively on the surgical outcome. This finding should be kept in mind for patient counseling and proper selection of surgical candidate.

Key Words: Tethered cord syndrome; Adulthood; Surgical outcome