Adult-Onset tethered cord Syndrome: Case series from a comprehensive interdisciplinary spine center
Introduction: Diagnosis, pathophysiology, and rationale for surgical intervention in adult-onset tethered cord syndrome (ATCS) remain controversial. In this population, comorbid degenerative spinal disease (DSD) and prior trauma may sometimes distract from radiologic evidence of TCS. Methods: We ret...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751923000567 |
| _version_ | 1827925656153882624 |
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| author | Owen P. Leary Matthew Hagan Patricia L. Zadnik Sullivan Abigail McElroy Sohail Syed David D. Liu John E. Donahue Keith-Austin Scarfo Alexios G. Carayannopoulos Justin Li Konstantina Svokos Jared S. Fridley Ziya L. Gokaslan Adetokunbo A. Oyelese Petra M. Klinge |
| author_facet | Owen P. Leary Matthew Hagan Patricia L. Zadnik Sullivan Abigail McElroy Sohail Syed David D. Liu John E. Donahue Keith-Austin Scarfo Alexios G. Carayannopoulos Justin Li Konstantina Svokos Jared S. Fridley Ziya L. Gokaslan Adetokunbo A. Oyelese Petra M. Klinge |
| author_sort | Owen P. Leary |
| collection | DOAJ |
| description | Introduction: Diagnosis, pathophysiology, and rationale for surgical intervention in adult-onset tethered cord syndrome (ATCS) remain controversial. In this population, comorbid degenerative spinal disease (DSD) and prior trauma may sometimes distract from radiologic evidence of TCS. Methods: We retrospectively reviewed electronic medical records of consecutive patients (2011–2019) presenting with back pain, lower extremity neurological symptoms, and/or urinary or bowel symptoms, who had radiologic evidence of fatty filum terminale (FT) and/or low-lying conus (LLC) in the setting of degenerative spine disease, and who underwent surgical detethering of the spinal cord. Medical history, presenting symptoms, MRI reports, and postoperative outcome data were collected and summarized. FT specimens were analyzed using histology and transmission electron microscopy (TEM). Correlation of preoperative characteristics with outcome were assessed using multivariate logistic regression. Results: Forty-nine patients (mean age 47.9 ± 17.6 years) diagnosed with ATCS were included. Nineteen (38.8 %) had undergone prior spine surgery. From baseline to one-month post-op, the proportion of patients with neurologic symptoms decreased from 100 % to 77.8 % (p < 0.001), back pain from 87.8 % to 48.9 % (p < 0.001), urinary symptoms from 79.6 % to 26.7 % (p < 0.001), and bowel symptoms from 34.7 % to 6.7 % (p < 0.001). Differences remained significantly lower at three-months and 12-months postoperatively (p < 0.05). On MRI, LLC was seen in 75.5 % of patients, fatty FT in 8.2 %, and filum lipoma in 69.4 %. Evidence of DSD was observed in 87.7 % of patients, and prior trauma was reported by 32.7 %, neither of which was correlated with surgical outcome. Forty-six FT specimens were assessed for histology, and 26 for TEM. In addition to known neuronal components of the FT, the collagen ultrastructure revealed collagen corkscrewing and beading (57.7 %) and fibril swelling (57.7 %) on TEM. Conclusions: Surgical intervention resulted in symptom improvement including resolution of urinary incontinence for many patients diagnosed with ATCS, even in the presence of comorbid degenerative spine pathology. |
| first_indexed | 2024-03-13T05:28:07Z |
| format | Article |
| id | doaj.art-17c8b9b34c344167ac5f3f5ed4264d24 |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-03-13T05:28:07Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
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| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-17c8b9b34c344167ac5f3f5ed4264d242023-06-15T04:56:16ZengElsevierInterdisciplinary Neurosurgery2214-75192023-09-0133101773Adult-Onset tethered cord Syndrome: Case series from a comprehensive interdisciplinary spine centerOwen P. Leary0Matthew Hagan1Patricia L. Zadnik Sullivan2Abigail McElroy3Sohail Syed4David D. Liu5John E. Donahue6Keith-Austin Scarfo7Alexios G. Carayannopoulos8Justin Li9Konstantina Svokos10Jared S. Fridley11Ziya L. Gokaslan12Adetokunbo A. Oyelese13Petra M. Klinge14Dept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Corresponding author at: Warren Alpert Medical School of Brown University, Rhode Island Hospital, APC-6, 593 Eddy Street, Providence, RI 02903, USA.Dept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Norman Prince Spine Institute, Rhode Island Hospital, Providence RI 02903, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; University of Massachusetts Chan Medical School, Worcester MA 01655, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Norman Prince Spine Institute, Rhode Island Hospital, Providence RI 02903, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Dept. of Neurosurgery, Brigham & Women’s Hospital, Boston MA 02115, USADept. of Pathology & Laboratory Medicine, Warren Alpert Medical School of Brown University & Rhode Island Hospital, Providence RI 02903, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Norman Prince Spine Institute, Rhode Island Hospital, Providence RI 02903, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Norman Prince Spine Institute, Rhode Island Hospital, Providence RI 02903, USA; Dept. of Physical Medicine & Rehabilitation, Warren Alpert Medical School of Brown University, Providence RI 02903, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Norman Prince Spine Institute, Rhode Island Hospital, Providence RI 02903, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Norman Prince Spine Institute, Rhode Island Hospital, Providence RI 02903, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Norman Prince Spine Institute, Rhode Island Hospital, Providence RI 02903, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Norman Prince Spine Institute, Rhode Island Hospital, Providence RI 02903, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Norman Prince Spine Institute, Rhode Island Hospital, Providence RI 02903, USADept. of Neurosurgery, Warren Alpert Medical School of Brown University, Providence RI, USA; Norman Prince Spine Institute, Rhode Island Hospital, Providence RI 02903, USAIntroduction: Diagnosis, pathophysiology, and rationale for surgical intervention in adult-onset tethered cord syndrome (ATCS) remain controversial. In this population, comorbid degenerative spinal disease (DSD) and prior trauma may sometimes distract from radiologic evidence of TCS. Methods: We retrospectively reviewed electronic medical records of consecutive patients (2011–2019) presenting with back pain, lower extremity neurological symptoms, and/or urinary or bowel symptoms, who had radiologic evidence of fatty filum terminale (FT) and/or low-lying conus (LLC) in the setting of degenerative spine disease, and who underwent surgical detethering of the spinal cord. Medical history, presenting symptoms, MRI reports, and postoperative outcome data were collected and summarized. FT specimens were analyzed using histology and transmission electron microscopy (TEM). Correlation of preoperative characteristics with outcome were assessed using multivariate logistic regression. Results: Forty-nine patients (mean age 47.9 ± 17.6 years) diagnosed with ATCS were included. Nineteen (38.8 %) had undergone prior spine surgery. From baseline to one-month post-op, the proportion of patients with neurologic symptoms decreased from 100 % to 77.8 % (p < 0.001), back pain from 87.8 % to 48.9 % (p < 0.001), urinary symptoms from 79.6 % to 26.7 % (p < 0.001), and bowel symptoms from 34.7 % to 6.7 % (p < 0.001). Differences remained significantly lower at three-months and 12-months postoperatively (p < 0.05). On MRI, LLC was seen in 75.5 % of patients, fatty FT in 8.2 %, and filum lipoma in 69.4 %. Evidence of DSD was observed in 87.7 % of patients, and prior trauma was reported by 32.7 %, neither of which was correlated with surgical outcome. Forty-six FT specimens were assessed for histology, and 26 for TEM. In addition to known neuronal components of the FT, the collagen ultrastructure revealed collagen corkscrewing and beading (57.7 %) and fibril swelling (57.7 %) on TEM. Conclusions: Surgical intervention resulted in symptom improvement including resolution of urinary incontinence for many patients diagnosed with ATCS, even in the presence of comorbid degenerative spine pathology.http://www.sciencedirect.com/science/article/pii/S2214751923000567Tethered cord syndromeFilum terminaleDegenerative disc diseaseElectron microscopy |
| spellingShingle | Owen P. Leary Matthew Hagan Patricia L. Zadnik Sullivan Abigail McElroy Sohail Syed David D. Liu John E. Donahue Keith-Austin Scarfo Alexios G. Carayannopoulos Justin Li Konstantina Svokos Jared S. Fridley Ziya L. Gokaslan Adetokunbo A. Oyelese Petra M. Klinge Adult-Onset tethered cord Syndrome: Case series from a comprehensive interdisciplinary spine center Interdisciplinary Neurosurgery Tethered cord syndrome Filum terminale Degenerative disc disease Electron microscopy |
| title | Adult-Onset tethered cord Syndrome: Case series from a comprehensive interdisciplinary spine center |
| title_full | Adult-Onset tethered cord Syndrome: Case series from a comprehensive interdisciplinary spine center |
| title_fullStr | Adult-Onset tethered cord Syndrome: Case series from a comprehensive interdisciplinary spine center |
| title_full_unstemmed | Adult-Onset tethered cord Syndrome: Case series from a comprehensive interdisciplinary spine center |
| title_short | Adult-Onset tethered cord Syndrome: Case series from a comprehensive interdisciplinary spine center |
| title_sort | adult onset tethered cord syndrome case series from a comprehensive interdisciplinary spine center |
| topic | Tethered cord syndrome Filum terminale Degenerative disc disease Electron microscopy |
| url | http://www.sciencedirect.com/science/article/pii/S2214751923000567 |
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