gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Postoperative tethered cord: Notice it, detect it and treat it – A diagnostic algorithm

Meeting Abstract

  • A. Dimostheni - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • F.H. Ebner - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • M. Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • F. Roser - Klinik für Neurochirurgie, Universitätsklinikum Tübingen

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMI.02.10

DOI: 10.3205/11dgnc185, URN: urn:nbn:de:0183-11dgnc1850

Published: April 28, 2011

© 2011 Dimostheni et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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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.