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    Surgery for tethered cord syndrome: when and how?
    (2018) Yasar, Soner; Dogan, Adem; Kayhan, Sait; Kirmizigoz, Sahin; Kaplan, Ali; Kural, Cahit; Izci, Yusuf
    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.
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    Tethered cord syndrome: 5 year clinical experiences and surgical results
    (2018) Kacar, Yunus; Mehtiyev , Royal; Ramikhanov, Zaur; Kural, Cahit; Izci, Yusuf
    Aim: Occult spinal dysraphism, which manifests with motor and sensory disturbances in children and causes orthopedic deformities in the lower extremities and urological findings, is the result of developmental defects in the caudal part of the neural tube. One of the most common spinal dysraphism is tethered cord syndrome (TCS). In this study, patients who had been diagnosed with TCS in the past 5 years were retrospectively reviewed and clinical, radiological and surgical characteristics of these patients were tried to be revealed. Material and Methods: We retrospectively reviewed the data about 26 patients with the diagnosis of TCS in our clinic between 2011- 2015. The results of these surgeries were evaluated by age, gender, additional malformations, clinic symptoms, radiological and electrophysiological evaluation. The patient with urological symptoms was additionally performed in urodynamic tests. Results: These 26 cases, 23% were children and 77% were adults. 81% of the patients were male and 19% female. Only 3.8% of the patients were primary TCS, 96.2% of the patients had other malformations. Urine incontinence was found in 19.2% of the patients and orthopedic deformities were found in 7.7% of the patients. Surgical treatment was done to 65% of the patients, and 35% of the patients were followed because they didn’t want to be operated. Conclusion: Tethered cord syndrome is usually not seem alone, it is associated with other developmental defects of the spine and spinal cord. If surgery done earlier, the greater the likelihood of regression of the neurological deficit or stablization the deficits.