Tethered spinal cord release is a fairly routine surgical procedure used to treat a tethered spine. There are two types of tethered spinal cord release surgery. In the simplest and most common form, a neurosurgeon makes a small opening in the back of the spine, below the end of the spinal cord, to cut the filum terminale, which is a band of tissue at the end of the spinal cord. This is a short procedure with very low risks.
The pain is often characterized as being constant, intractable, and aggravated by movement. Sensory loss is usually patchy and does not follow a dermatomal pattern. Motor weakness may be subtle and in only one muscle group. The patient may have a history of increased falls, decreased endurance, or decreased ambulation distance.
A past medical history should include questions of any orthopedic deformities hemivertebrae, leg length discrepancy, pes cavus, equinus deformityscoliosis, and toe walking.
A family history of first- and second-degree relatives is taken to determine if there is a genetic pattern. The lumbosacral spine and coccygeal area are inspected for cutaneous manifestations hairy patch, hemangioma, dimple, lumbosacral mass, or caudal tail.
A thorough neurologic examination consisting of sensory pinprick and light touch La tethered each dermatome and motor examinations manual motor testingdeep tendon reflexes, and gait assessment is obtained. The clinician examines feet for pes cavus and equinus deformities and the legs for leg length discrepancies and spasticity.
Sensory loss tends to be in a nonsegmental distribution. Variable deep tendon reflexes and tone are found. There may be asymmetric motor weakness and atrophy. The clinician should compare previous examinations if possible.
Functional assessment A functional history is taken to determine a decrease in independence or new use of an assistive device. Prior function previous to onset of symptoms is asked, with focus on transfers and mobility.
In children, achievement of developmental milestones independence with sitting, standing, walking, and toilet training are asked. Inquiries should also be made about any possible loss of milestones previously attained.
Imaging Radiographic findings must always be taken in context with the clinical symptoms when making the diagnosis of TCS, but a number of different imaging modalities may be utilized to help with evaluation and surgical planning.
Scoliosis films may be used to detect progression in the cobb angle as a symptom of tethered cord syndrome. A plain spine x-ray can be helpful to detect spina bifida occulta.
MRI is the current gold standard for diagnosis. The images usually show a low-lying cord below the level of L and a thickened filum terminale with a diameter greater than 2mm.
It is postulated that a tethered cord will be identified in a more posterior position using this technique. Once again, the clinician must look at the constellation of presenting symptoms and correlate them with radiographic findings. Thus, MRI is used for planning of surgery rather than diagnosis in most cases with prior known surgical intervention due to spinal dysraphism.
But the clinician must rule out other causes for the neurological symptoms, such as syrinx, herniated nucleus pulposus, infection, tumor, etc.
CT scans are also frequently obtained for better bony imaging and surgical planning. Due to the absence of a bony arch in spina bifida patients and the lack of lumbar ossification, ultrasound may be used in infants of less than months to prevent exposure to radiation and sedation.
As such, it is recommended that symptomatic children screened by ultrasound in infancy have an MRI later on in life. The urodynamic studies show abnormalities before clinical urologic symptoms appear. Children in the control group showed a score of 3.
In only the last few years, routine neurophysiologic monitoring utilized during tethered cord surgeries in Canada have led to another possible supplemental assessment tool. TCS patients, when compared to controls undergoing spinal surgery for scoliosis, tend to have a prolonged P37 peak in their somatosensory evoked potentials SSEP.
The P37 peak represents the arrival of sensory information from the limb to the somatosensory cortex.Eventbrite - United Way of Calvert County presents Early Morning Tethered Ride Reservations - Saturday, July 14, at Jefferson Patterson Park and Museum, Saint Leonard, MD.
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