Artikel
Postoperative tethered cord: Notice it, detect it and treat it – A diagnostic algorithm
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Autoren
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A. Dimostheni
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen
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F.H. Ebner
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen
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M. Tatagiba
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen
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F. Roser
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen
| Veröffentlicht: | 28. April 2011 |
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Gliederung
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Objective: Postoperative tethered cord can develop after intramedullary spinal cord surgery. Symptoms and neuroradiological findings can be subtle and may be overseen. However, treatment is simple once the tethering is detected. We present the incidence of postoperative tethered cord after intramedullary spinal cord surgery, the clinical course of patients and the diagnostic and treatment algorithm in these patients.
Methods: Nineteen consecutive cases with a secondary tethered cord were treated by operative (2004–2010). The cause of the postoperative tethered cord was a spinal cord tumor resection (n=8), a decompression of a Chiari malformation (n=5), a decompression and fusion of the spinal canal (n=3) and a syrinx shunt in one case. All patients recovered very well from their first operation with a significant improvement in neurological symptoms. However, all patients developed a neurological deterioration after their first surgery (7 months to 23 years, mean of 8.7 years), and suffered from increasing motor and sensory deficits. In addition, electrophysiological deterioration was detected in all cases. MRI T2-weighted CISS sequences showed arachnopathic lesions or adhesions at the former surgical site. Subsequently, the patient underwent a microsurgical detethering with the implementation of an enlarging duraplasty. Six previously implanted syrinx-shunts were explanted.
Results: A gradual improvement of neurological deficits with regressive motor and sensory loss symptoms could be seen in all patients (follow-up of mean 14 months). This has been confirmed in the electrophysiological follow-up examination and in the MRI-scans which showed fewer adhesions and free CSF circulation in the flow-studies.
Conclusions: Neurological deterioration after initial improvement in patients with a treated spinal cord pathology strongly suggest a postoperative tethered cord. A meticulous diagnostic workup with thin-sliced high resolution MRI can detect the focal pathology. Patients do benefit from secondary detethering and enlarging duraplasty.
