Ag. Filler et al., ADULT POSTREPAIR MYELOMENINGOCOELE AND TETHERED CORD SYNDROME - GOOD SURGICAL OUTCOME AFTER ABRUPT NEUROLOGICAL DECLINE, British journal of neurosurgery, 9(5), 1995, pp. 659-666
Adults who have had repair of an open myelomeningocoele at birth are s
usceptible to a variant of adult onset tethered cord syndrome (ATCS).
Precipitous and profound loss of lower extremity motor function occurr
ed in two postrepair adult patients, but was not seen in any of our 12
cases of adult tethered cord with any other aetiologies. Both postrep
air ATCS patients made a good recovery after surgical release of the t
ether. For the patients with other aetiologies, surgery yielded improv
ement or recovery of urinary continence in 57%, relief from pain in 78
% and improved strength in 80%. Evidence of retethering was observed i
n 25% of the operated patients at intervals ranging from 1 to 9 years
postoperatively. We conclude that surgical release of tether can rever
se incontinence in ATCS of any aetiology and that in the post-myelomen
ingocoele repair patient, both dexamethasone and surgical intervention
are helpful in reversing acute neurological deterioration.