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CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0044-1782689
Original Article

A Study of Outcome of Detethering in Delayed Presentation of Tethered Cord Syndrome

Hemant Kumar Beniwal 
1   Department of Neurosurgery, Beniwal Sadan, Churu, Rajasthan, India
,
N. Pratap K.
2   Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
,
Prakash Rao G.
2   Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
,
K. Srinivas
2   Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
,
Krishnamurthy Talari
2   Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
,
Uday Goutam Nookathota
2   Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
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Abstract

Introduction Tethered cord syndrome (TCS) is a stretch-induced functional disorder associated with tethering of caudal spinal cord to dura mater with inelastic tissue, limiting its movement. It not only manifests in childhood but also noted in adults. Here, we studied the role of detethering on delayed presentation of TCS.

Material and Methods All patients of symptomatic TCS from January 2011 to December 2019 were included. Preoperative evaluation was done through X-ray; ultrasonography kidney, ureter, urinary bladder; magnetic resonance imaging spine and brain; and urodynamic studies. Detethering was done and associated pathology was excised. Preoperative and postoperative comparison was done through Necker functional score using chi-squared system.

Results Age range was 8 to 30 years with mean age of 13.8 years. Most common presentation was urological manifestations in ∼61.1% of cases followed by pain in 41.6%, sensory deficits in 38.8%, asymmetric weakness in 30.5%, orthopaedic and trophic ulcers in 22.2% each, and bowel abnormalities in 13.8% of cases. Mean duration of symptoms was 5.52 years. Improvement in urological manifestations was in 71.4% patients, pain in 80%, sensory dysfunctions in 71.4%, bowel dysfunctions in 80%, motor weakness in 90.9%, and trophic ulcer in 100% patients. On comparison, chi-squared value was 25.9993 and p-value was 0.000032, which was significant (<0.05).

Conclusion Detethering in early ages is already proven with good results. In our study, detethering showed statistically significant improvement even in delayed presentation. So, authors recommend to surgically interfere by detethering, even if tethering is detected late with significant deficits.

Keywords

tethered cord syndrome (TCS) - Necker functional score - chi-squared value


Publication History

Article published online:
03 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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