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Scoliosis may be the first symptom of the tethered spinal cord

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Abstract

Background: Tethered cord syndrome (TCS) is a progressive clinical entity that arises from abnormal spinal cord tension. Scoliosis may be a unique symptom in TCS. The aim of this study is to investigate prognosis after releasing the filum terminale in scoliosis due to TCS with/without findings in magnetic resonance imaging (MRI) and to draw attention to the importance of somatosensorial evoked potentials (SSEP) on the differential diagnosis of idiopathic scoliosis versus scoliosis due to TCS with normal appearance of filum terminale and conus medullaris.

Materials and Methods: Eleven female and seven male patients with progressive scoliosis were included in the study. They were evaluated radiologically, SSEP and urodynamical studies. Preoperative and postoperative anteroposterior full spine X-rays were obtained for measuring the Cobb’s angle. MRI was performed in all cases for probable additional spinal abnormalities. All patients underwent filum terminale sectioning through a L5 hemilaminectomy. The resected filum terminale were subjected to histopathological examination.

Results: The mean Cobb angle was 31.6° (range 18°–45°). Eight patients (44.45%) had a normal appearance of filum terminale and normal level conus medullaris in MRI, but conduction delay and/or block was seen on SSEP. In the histopathological examination of filum terminale dense collagen fibers, hyaline degeneration and loss of elastic fibers were observed. Postoperatively none of the patients showed worsening of the Cobb angle. Three patients showed improvement of scoliosis.

Conclusion: In TCS presented with scoliosis, untethering must be performed prior to the corrective spinal surgery. Absence of MRI findings does not definitely exclude TCS. SSEP is an important additional guidance in the diagnosis of TCS. After untethering, a followup period of 6 months is essential to show it untethering helps in stopping the progress of the scoliotic curve. In spite of non progression (curve stopped lesser than 45°) or even improvement of scoliosis, there may be no need for major orthopedic surgical intervention.

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References

  1. Giddens JL, Radomski SB, Hirshberg ED, Hassouna M, Fehlings M. Urodynamic findings in adults with the tethered cord syndrome. J Urol 1999;161:1249–54.

    Article  CAS  Google Scholar 

  2. Hoffman HJ, Hendrick EB, Humphreys RP. The tethered spinal cord: Its protean manifestations, diagnosis and surgical correction. Childs Brain 1976;2:145–55.

    CAS  PubMed  Google Scholar 

  3. McGirt MJ, Mehta V, Garces-Ambrossi G, Gottfried O, Solakoglu C, Gokaslan ZL, et al. Pediatric tethered cord syndrome: Response of scoliosis to untethering procedures. Clinical article. J Neurosurg Pediatr 2009;4:270–4.

    Article  Google Scholar 

  4. McLone DG, Herman JM, Gabrieli AP, Dias L. Tethered cord as a cause of scoliosis in children with a myelomeningocele. Pediatr Neurosurg 1990;16:8–13.

    Article  Google Scholar 

  5. Pierz K, Banta J, Thomson J, Gahm N, Hartford J. The effect of tethered cord release on scoliosis in myelomeningocele. J Pediatr Orthop 2000;20:362–5.

    CAS  PubMed  Google Scholar 

  6. Yamada S, Won DJ, Yamada SM. Pathophysiology of tethered cord syndrome: Correlation with symptomatology. Neurosurg Focus 2004;16:E6.

    Article  Google Scholar 

  7. Fabiano AJ, Khan MF, Rozzelle CJ, Li V. Preoperative predictors for improvement after surgical untethering in occult tight filum terminale syndrome. Pediatr Neurosurg 2009;45:256–61.

    Article  Google Scholar 

  8. Hertzler DA 2nd, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: A review of the literature from embryology to adult presentation. Neurosurg Focus 2010;29:E1.

    Article  Google Scholar 

  9. Selçuki M, Vatansever S, Inan S, Erdemli E, Bagdatoglu C, Polat A. Is a filum terminale with a normal appearance really normal? Childs Nerv Syst 2003;19:3–10.

    Article  Google Scholar 

  10. Weiss HR, Moramarco M. Indication for surgical treatment in patients with adolescent Idiopathic Scoliosis-a critical appraisal. Patient Saf Surg 2013;7:17.

    Article  Google Scholar 

  11. Chern JJ, Dauser RC, Whitehead WE, Curry DJ, Luerssen TG, Jea A. The effect of tethered cord release on coronal spinal balance in tight filum terminale. Spine (Phila Pa 1976) 2011;36:E944–9.

    Article  Google Scholar 

  12. Fletcher ND, Larson AN, Richards BS, Johnston CE. Current treatment preferences for early onset scoliosis: A survey of POSNA members. J Pediatr Orthop 2011;31:326–30.

    Article  Google Scholar 

  13. Piazzolla A, Solarino G, De Giorgi S, Mori CM, Moretti L, De Giorgi G. Cotrel-Dubousset instrumentation in neuromuscular scoliosis. Eur Spine J 2011;20 Suppl 1:S75–84.

    Article  Google Scholar 

  14. Selçuki M, Coskun K. Management of tight filum terminale syndrome with special emphasis on normal level conus medullaris (NLCM). Surg Neurol 1998;50:318–22.

    Article  Google Scholar 

  15. Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am 1997;79:364–8.

    Article  CAS  Google Scholar 

  16. Sud A, Tsirikos AI. Current concepts and controversies on adolescent idiopathic scoliosis: Part II. Indian J Orthop 2013;47:219–29.

    Article  Google Scholar 

  17. Kesler H, Dias MS, Kalapos P. Termination of the normal conus medullaris in children: A whole-spine magnetic resonance imaging study. Neurosurg Focus 2007;23:E7.

    Article  Google Scholar 

  18. Khanna AJ, Wasserman BA, Sponseller PD. Magnetic resonance imaging of the pediatric spine. J Am Acad Orthop Surg 2003;11:248–59.

    Article  Google Scholar 

  19. Porter RW. Idiopathic scoliosis: The relation between the vertebral canal and the vertebral bodies. Spine (Phila Pa 1976) 2000;25:1360–6.

    Article  CAS  Google Scholar 

  20. Schijman E. Split spinal cord malformations: Report of 22 cases and review of the literature. Childs Nerv Syst 2003;19:96–103.

    Article  Google Scholar 

  21. Selçuki M, Unlü A, Ugur HC, Soygür T, Arikan N, Selçuki D. Patients with urinary incontinence often benefit from surgical detethering of tight filum terminale. Childs Nerv Syst 2000;16:150–4.

    Article  Google Scholar 

  22. Umur AS, Selcuki M, Selcuki D, Bedük A, Doganay L. Adult tethered cord syndrome mimicking lumbar disc disease. Childs Nerv Syst 2008;24:841–4.

    Article  Google Scholar 

  23. Wiley JW, Thomson JD, Mitchell TM, Smith BG, Banta JV. Effectiveness of the Boston brace in treatment of large curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2000;25:2326–32.

    Article  CAS  Google Scholar 

  24. Acaroglu E, Alanay A, Akalan N, Atilla B, Bulutçu E, Surat A. Risk factors associated with corrective surgery in congenital scoliosis with tethered cord. Turk J Pediatr 1997;39:373–8.

    CAS  PubMed  Google Scholar 

  25. Kale SS, Mahapatra AK. The role of somatosensory evoked potentials in spinal dysraphism–Do they have a prognostic significance? Childs Nerv Syst 1998;14:328–31.

    Article  CAS  Google Scholar 

  26. Weinstein SL. Natural history. Spine (Phila Pa 1976) 1999;24:2592–600.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Celal Bayar University School of Medicine, Turkey

    Mustafa Barutçuoğlu, Mehmet Selçuki, Ahmet Sukru Umur & Mesut Mete

  2. Department of Histology and Embryology, Celal Bayar University Vocational School of Health Services, Turkey

    Seren Gulsen Gurgen

  3. Department of Neurology, Celal Bayar University School of Medicine, Turkey

    Deniz Selcuki

Authors
  1. Mustafa Barutçuoğlu
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  2. Mehmet Selçuki
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  3. Ahmet Sukru Umur
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  4. Mesut Mete
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  5. Seren Gulsen Gurgen
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  6. Deniz Selcuki
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Correspondence to Mustafa Barutçuoğlu.

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Barutçuoğlu, M., Selçuki, M., Umur, A.S. et al. Scoliosis may be the first symptom of the tethered spinal cord. IJOO 50, 80–86 (2016). https://doi.org/10.4103/0019-5413.173506

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  • DOI: https://doi.org/10.4103/0019-5413.173506

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