EVALUATION OF OUTCOMES FOLLOWING DETETHERING SURGERY IN PATIENTS WITH DELAYED PRESENTATION OF TETHERED CORD SYNDROME

Abstract

Background: TCS (Tethered cord syndrome) is a functional disorder which is stretch-induced and is associated with
tethering in the caudal spinal cord to the dura meter with inelastic tissue which limits its movement. Tethered cord
syndrome does not only manifest in the child subjects but also progress to the adulthood.
Aim: The present study was aimed to evaluate the outcomes following detethering surgery in patients with delayed
presentation of tethered cord syndrome.
Methods: The present study assessed all the subjects that had symptomatic Tethered cord syndrome and presented to the
Institute within the defined study period. All the subjects were assessed preoperatively using X-rays as ultrasonography
for urinary bladder, ureter, and kidney along with urodynamic studies and MRI (magnetic resonance imaging) of brain
and spine. Detethering was done and the pathological lesion was excised. Postoperative and preoperative comparison was
made using Necker functional score and statistical tests.
Results: The study subjects were aged 8-30 years with mean age of 13.6 years. Urological manifestations were most
commonly seen followed by pain, sensory deficits, asymmetric weakness, trophic and orthopedic ulcers, and bowel
abnormalities in 61%, 42%, 39%, 30%, 22%, and 14% study subjects respectively. Mean symptom duration was 5.50
years. Improvements for urological manifestations, pain, sensory deficits, bowel dysfunction, motor weakness, and
trophic ulcers was seen in 71%, 80%, 71%, 80%, 91%, and 100% subjects respectively. Comparison results showed a
significant difference with p=0.003.
Conclusion: The present study concludes that detethering done in early age of affected subjects is a proven technique
with the good results. Detethering result in significant improvement in subjects that have delayed presentation. Hence, it
is recommended to interfere surgically by detethering even if tethering is presented late with significant details