Tethered cord syndrome in adults

BACKGROUND The tethered cord syndrome (TCS) is usually diagnosed in childhood and its symptomatic onset in adult life is not common. In the present study, we ana lyzed the data of patients who presented with TCS in adulthood with the aim of studying the clinical spectrum and management strategies. CLINICAL MATERIAL Over a 5-year period, 18 adult patients (more than 18 years of age) with TC S were investigated with MRI and were operated on. Patients with adult TCS could be divided into two groups. Group 1 included patients who were asympt omatic in childhood and presented for the first time in adult life (10 pati ents). The second group was comprised of patients with preexisting static s keletal/ neurological deformities who presented in adult life with new or p rogressive symptoms (eight patients). Eleven patients had cutaneous stigmat a, 15 had motor or sensory deficit, nine had back/leg pain, eight had leg a trophy, and six had sphincter disturbances. The most frequent MRI finding w as a low lying cord with an intradural and/or extradural lipoma. The cord w as detethered surgically and the tethering lesion excised. Pain was usually relieved after surgery (8 out of 9), but only a few patients (2 out of 6) had improvement of sphincter dysfunction. CONCLUSIONS The late presentation of TCS is possibly related to the degree of tethering and the cumulative effect of repeated microtrauma during flexion and exten sion. Adult patients with persistent back/leg pain and/or neurological or s keletal deformities should be investigated with MRI to establish an early d iagnosis. Surgery should be performed in all adult patients with TCS, once the diagnosis is established. (C) 1999 by Elsevier Science Inc.