Our Summary

Tethered Cord Syndrome (TCS) is a neurological condition caused by tension on the lower part of the spinal cord. The traditional treatment for this has been a surgery called detethering. However, in cases where the condition comes back, this surgery can potentially cause new neurological issues and it is difficult to prevent the condition from recurring. A possible alternative treatment is shortening the spinal column, which aims to reduce the tension on the spinal cord without the risks of the detethering surgery.

This research paper looks at the records of 16 adult patients with recurring TCS who had treatment between 2005 and 2018. Half of these patients had the spinal column shortening procedure, while the other half had the detethering surgery again. The researchers then compared various factors, such as patient characteristics, outcomes, and things that happened around the time of the surgery.

The results showed that in the group that had the spinal column shortening, no patients experienced complications and all either improved or remained the same in terms of lower body function and bladder control. In contrast, in the group that had the detethering surgery again, some patients experienced a worsening of lower body strength and bladder control, and some had complications related to the surgical wound.

However, the spinal column shortening procedure did involve more blood loss and a longer surgery time. Despite this, the researchers conclude that the outcomes were similar for both groups, but the shortening procedure may be a good alternative for patients with particularly complex cases or heavy scarring from previous surgeries.

FAQs

  1. What is Tethered Cord Syndrome and how is it traditionally treated?
  2. What alternative treatment to detethering surgery is suggested in this research paper?
  3. What were the outcomes of the spinal column shortening procedure compared to the repeated detethering surgery?

Doctor’s Tip

A doctor might tell a patient considering detethering surgery that there is an alternative treatment option called spinal column shortening, which can reduce the tension on the spinal cord without the potential risks of detethering surgery. This alternative treatment may be a good option for patients with complex cases or heavy scarring from previous surgeries. It is important to discuss all available options with your healthcare provider to determine the best course of action for your individual situation.

Suitable For

Patients who are typically recommended detethering surgery are those with Tethered Cord Syndrome (TCS) who have symptoms such as lower body weakness, pain, abnormal gait, and bladder or bowel dysfunction. These patients may have had a previous detethering surgery that was not successful or are at risk for recurrence of the condition. Additionally, patients with complex cases or heavy scarring from previous surgeries may be good candidates for the spinal column shortening procedure as an alternative treatment option.

Timeline

Before detethering surgery:

  1. Patient experiences symptoms of Tethered Cord Syndrome, such as lower back pain, leg weakness, and bladder dysfunction.
  2. Patient undergoes diagnostic tests, such as MRI or ultrasound, to confirm the diagnosis of TCS.
  3. Patient discusses treatment options with their healthcare provider, including the possibility of detethering surgery.

After detethering surgery:

  1. Patient undergoes the detethering surgery to release tension on the spinal cord.
  2. Patient may experience some pain and discomfort in the days following the surgery.
  3. Patient undergoes physical therapy to help regain strength and mobility in the lower body.
  4. Patient follows up with their healthcare provider for monitoring and management of any complications or recurrence of symptoms.
  5. In cases of recurring TCS, patient may consider alternative treatments, such as spinal column shortening, to address the underlying cause of the condition.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with detethering surgery?

  2. How likely is it that the TCS will recur after detethering surgery?

  3. What are the potential benefits of the spinal column shortening procedure compared to detethering surgery?

  4. How does the success rate of the spinal column shortening procedure compare to detethering surgery?

  5. Are there any specific factors that would make a patient a better candidate for the spinal column shortening procedure over detethering surgery?

  6. How long is the recovery time for the spinal column shortening procedure compared to detethering surgery?

  7. What is the expected outcome in terms of lower body function and bladder control for both procedures?

  8. Are there any specific follow-up care or rehabilitation requirements for patients who undergo the spinal column shortening procedure?

  9. How experienced is the medical team in performing the spinal column shortening procedure compared to detethering surgery?

  10. Are there any other alternative treatments or therapies that could be considered for TCS before resorting to surgery?

Reference

Authors: Zhang C, Chang CC, Mummaneni PV, Yuan C, Dhall S, Jian F, Gupta N, Chou D. Journal: J Neurosurg Spine. 2020 Feb 7;32(6):958-964. doi: 10.3171/2019.12.SPINE19659. Print 2020 Jun 1. PMID: 32032960