Our Summary

Tethered Cord Syndrome (TCS) is a condition in children where the spinal cord is stretched as the child grows. This can cause reduced blood flow to the spinal cord and result in neurological problems, such as pain in the legs and back, problems with the bowel or bladder, and weakness in the lower body. This study aimed to understand the symptoms of TCS better, how they change over time, and what factors might influence these symptoms.

The researchers looked at the medical records of 273 patients who underwent a surgery to untether the spinal cord at their institution between 2015 and 2019. They analyzed the symptoms of these patients and investigated whether certain factors like age, gender, and specific diagnostic markers were linked to these symptoms and their changes over time.

They found that children younger than 5 years old were less likely to have urological, gastrointestinal, and neurological or orthopedic symptoms. Patients with a certain condition (thickened filum) were less likely to have urological symptoms, and those with another condition (low-lying conus) were less likely to have gastrointestinal symptoms. Interestingly, they found that constipation was a common symptom, reported by 45% of patients.

Patients generally reported fewer symptoms at their first and second post-surgery visits compared to before the surgery. However, the decrease in symptoms over time was not related to any specific demographic or diagnostic factors.

In summary, this study provides valuable insights into the symptoms of TCS and their changes over time, which could help in the diagnosis and treatment of this condition.

FAQs

  1. What is Tethered Cord Syndrome (TCS) and what symptoms does it cause?
  2. What is detethering surgery and how does it impact the symptoms of TCS?
  3. Did the study find any specific factors that influence the symptoms of TCS and their changes over time?

Doctor’s Tip

One important tip that a doctor might give a patient about detethering surgery is to closely follow post-operative care instructions and attend all follow-up appointments. This is crucial for monitoring any changes in symptoms and ensuring proper healing and recovery. Additionally, maintaining a healthy lifestyle, including regular exercise and good nutrition, can help support overall spinal health and reduce the risk of complications. It’s also important to communicate openly with your healthcare team about any new or worsening symptoms that may arise after surgery. Regular communication and collaboration with your medical team can help ensure the best possible outcome following detethering surgery.

Suitable For

Patients who are typically recommended detethering surgery are those with Tethered Cord Syndrome (TCS) who are experiencing symptoms such as pain in the legs and back, problems with bowel or bladder function, weakness in the lower body, and other neurological issues. Younger children under the age of 5 may be less likely to have certain symptoms, while patients with specific conditions like thickened filum or low-lying conus may also exhibit different symptom profiles.

Overall, detethering surgery is recommended for patients with TCS who are experiencing symptoms that are impacting their quality of life and function. This surgery can help relieve the pressure on the spinal cord and improve symptoms over time.

Timeline

Timeline of a patient’s experience before and after detethering surgery:

Before surgery:

  1. Patient presents with symptoms such as pain in the legs and back, bowel or bladder problems, and weakness in the lower body.
  2. Patient undergoes diagnostic tests to confirm TCS, such as MRI or CT scans.
  3. Treatment options are discussed, and surgery is recommended to untether the spinal cord.

After surgery:

  1. Patient undergoes detethering surgery to release the spinal cord.
  2. In the immediate post-operative period, patient may experience pain and discomfort at the surgical site.
  3. Over time, patient’s symptoms improve, with fewer urological, gastrointestinal, and neurological or orthopedic symptoms reported at follow-up visits.
  4. Some patients may still experience constipation as a common symptom post-surgery.
  5. The decrease in symptoms over time is not related to any specific demographic or diagnostic factors.
  6. Regular follow-up visits are scheduled to monitor the patient’s progress and address any ongoing issues.

Overall, detethering surgery can significantly improve symptoms and quality of life for patients with TCS, with most experiencing a reduction in symptoms and improvement in function post-surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about detethering surgery include:

  1. What are the potential risks and complications associated with detethering surgery?
  2. How long is the recovery process after detethering surgery?
  3. Will I need physical therapy or rehabilitation after the surgery?
  4. How likely is it that my symptoms will improve or resolve after detethering surgery?
  5. Are there any specific lifestyle changes or restrictions I should follow post-surgery?
  6. How often will I need follow-up appointments after the surgery?
  7. Will I need any additional imaging or tests to monitor my condition after detethering surgery?
  8. Are there any specific factors that may affect the success of the surgery in my case?
  9. What is the typical outcome for patients who undergo detethering surgery?
  10. Are there any alternative treatment options available for Tethered Cord Syndrome that I should consider?

Reference

Authors: Howells M, Hamby T, Honeycutt J, Donahue DJ. Journal: Pediatr Neurosurg. 2022;57(2):85-92. doi: 10.1159/000522135. Epub 2022 Jan 21. PMID: 35066504