Surgery in adults with tethered cord syndrome: outcome study with independent clinical review

Object. The authors conducted a study to evaluate the risks and short-term benefits of surgical treatment for tethered cord syndrome (TCS) in patients older than 18 years of age. Methods. The authors studied a series of 57 consecutive adult patients with TCS of varying origins. Patients were examined by the same neurologist in a standardized fashion before and after surgery, and most were followed for at least 2 years postoperatively. Patient age ranged from 19 to 75 years. The mean age at onset of symptoms a nd diagnosis was 30 years and 37 years, respectively. Muscle strength impro ved (15 cases) or showed no change postoperatively (38 cases) in a large ma jority of patients (93%). In four patients a minor decrease in muscle stren gth was demonstrated, and there was significant deterioration in two (3.5%) . In the two latter patients, a rapid decline in motor function was present preoperatively. Subjective assessment of pain, gait, sensory function, and bladder/bowel function at 3 weeks, 6 months, and 2 years postsurgery revea led improvement in a substantial percentage of patients. No major surgery-r elated complications occurred. Conclusions. This is the largest series to date in which adult patients wit h TCS comprise the report. Untethering procedures in these patients were sa fe and effective, at least in the short term. Patients with rapid loss of m otor function, lipomyelomeningocele, or split cord malformation seem to be at a higher risk of postsurgery deterioration. A follow-up period of many m ore years will be necessary to determine whether aggressive surgery is bene ficial in the long term.