CONGENITAL TETHERED SPINAL-CORD SYNDROME IN ADULTS

Object. The management of tethered spinal cord syndrome with onset of symptomatology occurring in adulthood remains controversial, although the necessity of early surgery in the pediatric tethered cord syndrome population is well established. To ascertain the results of surgery i n adult patients with this anomaly, the authors undertook a retrospect ive review of 34 cases. Methods. The authors studied the hospital reco rds of 34 consecutive patients who presented in adulthood with tethere d cord syndrome and conducted follow-up phone interviews with 28 of th em. The population consisted of 12 men and 22 women, ranging in age fr om 18 to 70 years (mean 34 years). The most common presenting feature was pain, followed by weakness and incontinence. All patients underwen t surgery. The most common operative findings were tight filum termina le, split cord malformation, and lipomyelomeningocele, paralleling tho se observed in pediatric studies. Long-term surgical results and patie nt outcome ratings were encouraging. After a mean clinical follow-up p eriod of 4 years, significant improvement occurred in 22 of 27 patient s presenting with pain, 13 of 27 patients with motor or sensory dysfun ction, and 11 of 18 patients with bowel and bladder disturbance. In ad dition, telephone interviews were obtained after a period of 8.6 years . Twenty-two (79%) of 28 patients called the operation a long-term suc cess; 21 (75%) of 28 patients believed that they had significant posto perative improvement land not just stabilization)in pain and/or neurol ogical function. Surgical complications were generally minor. Nineteen (86%) of 22 employed patients returned to work after surgery. Two (33 %) of six patients who were not employed before surgery worked full ti me postoperatively. Only two of the 28 patients interviewed had receiv ed Workers' Compensation benefits; both of these had good outcomes and returned to work. Conclusions. Tethered spinal cord syndrome in adult s is an uncommon entity that can become symptomatic. Although surgery in adults involves greater risk of neurological injury than in childre n, it is a low-risk procedure with encouraging results. Because neurol ogical deficits are generally irreversible, early surgery is recommend ed.