Surgery for tethered cord syndrome: when and how?

Abstract

Tethered cord syndrome (TCS) is a clinical condition presented with neurological and/or urological signs and findings. Increased hypoxic stress in the spinal cord secondary to traction or stretching is the pathophysiological mechanism of TCS. It is usually observed in childhood but adult cases were also reported. Its diagnosis and treatment are always challenging. Magnetic resonance imaging, electrophysiological and urodynamic studies are the main diagnostic tools for TCS. This syndrome may be primary or secondary to previous surgeries such as myelomeningocele. Asymptomatic patients with low conus medullaris and thick filum terminale are always questionable for surgical treatment. On the other hand, symptomatic patients with normal radiological imaging are critical for surgical decision. Surgical treatment involves correction of the spinal pathologies and release of the spinal cord by cutting the filum terminale. Time of surgery and technical nuances are still in debate among neurosurgeons. Neurological and urological outcomes of the patients usually depend on these factors. Timing of surgery and surgical technique need to be clarified based on the recent clinical studies. This review will focus on the time and technique of TCS surgery. Firstly, a brief description of TCS will be provided, then an extensive view on the surgical treatment of TCS will be performed.