Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients

Sharad Rajpal M.D.1, R. Shane Tubbs M.A., P.A.-C., Ph.D.2, Timothy George M.D.3, W. Jerry Oakes M.D.2, Herbert E. Fuchs M.D., Ph.D.3, Mark N. Hadley M.D.2, and Bermans J. Iskandar M.D.1
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  • 1 Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin;
  • | 2 Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
  • | 3 Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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Object

Children with spina bifida occulta require early surgery to prevent neurological deficits. The treatment of patients with a congenitally tethered cord who present in adulthood remains controversial.

Methods

The authors studied the medical records of 61 adult patients who underwent surgical untethering for spina bifida occulta at three institutions between 1994 and 2003. Patients who had undergone prior myelomeningocele repair or tethered cord release surgery were excluded.

The most common intraoperative findings were lipomyelomeningocele (41%) and a tight terminal filum (36%). The follow-up duration ranged from 10.8 to 149.5 months. Of the 34 patients with back pain, status improved in 65%, worsened in 3%, remained unchanged in 18%, and improved and later recurred in 15%. Lower-extremity pain improved in 16 patients (53%), remained unchanged in 23%, improved and then recurred in 17%, and worsened in 7%. Lower-extremity weakness improved in 47%, remained unchanged in 47%, and improved and then recurred in 5%. Finally, of the 17 patients with lower-extremity sensory changes, status improved in 35%, remained unchanged in 35%, and the information on five patients was unavailable. Surgical complications included three wound infections, one cerebrospinal fluid leak, and two pseudomeningoceles requiring surgical revision. One patient developed acute respiratory distress syndrome and sepsis postoperatively and died several days later.

Conclusions

Adult-age presentation of a congenital tethered cord is unusual. Despite a slight increase in postoperative neurological injury in adults, surgery has relatively low risk and offers good potential for neurological improvement or stabilization. As they do in children, the authors recommend early surgery in adults with this disorder. The decision to undertake surgery, however, should be modulated by other factors such as a patient's general medical condition and risk posed by anesthesia.

Abbreviations used in this paper:

CSF = cerebrospinal fluid; EMG = electromyography; SCM = split cord malformation; SSEP = somatosensory evoked potential; TCR = tethered cord release; TCS = TC syndrome.

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Contributor Notes

Address reprint requests to: Bermans J. Iskandar, M.D., Department of Neurosurgery, University of Wisconsin Medical School, 600 Highland Avenue, Madison, Wisconsin. email: iskandar@neurosurg.wisc.edu.
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