From the Guidelines
Tethered cord syndrome in adults is a serious condition that requires prompt surgical intervention to prevent progressive neurological damage and improve quality of life, as evidenced by the clinical manifestations and long-term consequences described in 1. The clinical signs and symptoms of spinal cord tethering in adults are diverse and can include pain, sensorimotor disturbances of the lower limbs, difficulties with bladder and/or bowel control, and orthopedic deformities of the feet and spine deformities, such as progressive scoliosis and exaggerated lumbosacral lordosis, as noted in 1. Some key points to consider in the management of tethered cord syndrome in adults include:
- The sudden appearance of new pain and/or neurologic deficits after a sudden back stretching, such as during childbirth, falls onto the buttocks, vigorous sporting activities, and automobile crashes, is a characteristic feature of tethered cord syndrome in adults, as described in 1.
- Long-standing untreated tethering can ultimately result in progressive musculoskeletal deformities and/or scoliosis, as well as muscle weakness and gait disturbances, as discussed in 1.
- Adults who become symptomatic often have a history of subtle abnormalities dating back to early childhood, such as being "slow" athletically, having difficulties with chronic constipation, or being late in toilet training, as mentioned in 1.
- Surgical detethering is typically recommended for symptomatic patients, which entails releasing the spinal cord from abnormal attachments through a laminectomy procedure, with the goal of preventing further neurological decline and improving quality of life, as implied by the clinical manifestations described in 1.
From the Research
Implications of Tethered Cord Syndrome in Adults
The implications of tethered cord syndrome in adults can be significant, with various symptoms and complications arising from the condition. Some of the key implications include:
- Pain: The most common complaint among adults with tethered cord syndrome, with studies showing that pain is the predominant symptom in this population 2, 3, 4.
- Neurological deficits: Muscular weakness, urinary incontinence, and sensory deficits are common neurological findings in adults with tethered cord syndrome 2, 5, 4.
- Co-malformations: Diastematomyelia, vertebral fusion anomalies, and lipomyelomeningocele are common co-malformations associated with tethered cord syndrome in adults 2, 5, 4.
- Surgical complications: Cerebrospinal fluid leakage, infective complications, and worsening of neurological symptoms are potential complications of surgical treatment for tethered cord syndrome in adults 2, 5.
Surgical Outcomes
Surgical outcomes for adults with tethered cord syndrome are generally favorable, with most patients experiencing improvement or stabilization of their symptoms. Some key findings include:
- Improvement in pain: Studies have shown that surgical untethering can lead to significant improvement in pain symptoms in adults with tethered cord syndrome 3, 5, 4.
- Improvement in neurological symptoms: Surgical treatment can also lead to improvement in neurological symptoms such as muscular weakness, sensory deficits, and bladder dysfunction 3, 5, 4.
- Low complication rate: The overall post-operative complication rate is low, although complications such as cerebrospinal fluid leakage and infective complications can occur 2, 5.
Factors Associated with Outcome
Several factors have been identified as being associated with outcome in adults with tethered cord syndrome, including:
- Split cord malformation: This co-malformation has been associated with a higher risk of postoperative deterioration and poor outcome 4.
- Lipomyelomeningocele: This co-malformation has also been associated with a higher risk of postoperative deterioration and poor outcome 4.
- Previous surgery: Adults with a history of previous surgery for tethered cord syndrome may be at higher risk of complications and poor outcome 4.
- Delay in diagnosis: A long delay in diagnosis can lead to worse outcomes, highlighting the importance of early diagnosis and treatment 4.