Abstract
Occult spinal dysraphisms (OSDs) are congenital deteriorations that can lead to serious symptoms. OSD generally appears in children, the most common form in adults being tethered cord. Patients harboring OSD can experience a wide spectrum of clinical presentations ranging from asymptomatic to paraplegic. Although good results have been reported after surgical interventions for symptomatic OSD in adults, surgical intervention such as tethered cord releasing is a complex procedure and has serious complications. Therefore, it is suggested that surgery be planned according to dominant symptoms and by full neurological examination, craniospinal imaging, and urodynamic tests. Laminoplasty (or hemilaminectomy), short-term (less than 6 months) symptoms, patients without lipomas, and presentation with moderate or mild symptoms seem to be reliable predictors for good surgical outcomes. Urodynamic study can be used as a predictive tool for diagnosing OSD in asymptomatic adult patients and can be a guide for disease prognosis. Intraoperative neurophysiological monitoring of nerve roots is useful for distinguishing those that are functional from that are not. Thus, neurosurgeons can reduce the serious complications that can result from surgical intervention for OSD cases in adults.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abdallah A, Emel E, Güler Abdallah B, Asiltürk M, Sofuoğlu ÖE. Factors affecting the surgical outcomes of tethered cord syndrome in adults: a retrospective study. Neurosurg Rev. 2018;41(1):229–39.
Kokubun S, Ozawa H, Aizawa T, Ly NM, Tanaka Y. Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. J Neurosurg Spine. 2011;15:21–7.
Phuong LK, Schoeberl KA, Raffel C. Natural history of tethered cord in patients with meningomyelocele. Neurosurgery. 2002;50:989–95.
Hoffman HJ, Hendrick EB, Humphreys RP. The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Childs Brain. 1976;2:145–55.
Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA. Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg. 2009;34:114–20.
Klekamp J. Tethered cord syndrome in adults. J Neurosurg Spine. 2011;15:258–70.
Kural C, Guresci S, Simsek GG, Arslan E, Tehli O, Solmaz I, Izci Y. Histological structure of filum terminale in human fetuses: laboratory investigation. J Neurosurg Pediatr. 2014;13(4):362–7.
Lee GY, Paradiso G, Tator CH, Gentili F, Massicotte EM, Fehlings MG. Surgical management of tethered cord syndrome in adults: indications, techniques, and long-term outcomes in 60 patients. J Neurosurg Spine. 2006;4(2):123–31.
Rajpal S, Tubbs RS, George T, Oakes WJ, Fuchs HE, Hardley MN, Iskandar BJ. Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients. J Neurosurg Spine. 2007;6:210–5.
Sofuoğlu ÖE, Abdallah A, Emel E, Ofluoğlu AE, Güneş M, Güler B. Management of tethered cord syndrome in adults: experience of 23 cases. Turk Neurosurg. 2017;27(2):227–36.
Van Leeuwen R, Notermans NC, Vandertop WP. Surgery in adults with tethered cord syndrome: outcome study with independent clinical review. J Neurosurg. 2001;94(suppl 2):205–9.
Tehli O, Hodaj I, Kural C, Solmaz I, Onguru O, Izci Y. A comparative study of histopathological analysis of filum terminale in patients with tethered cord syndrome and in normal human fetuses. Pediatr Neurosurg. 2011;47:412–6.
Lapsiwala SB, Iskandar BJ. The tethered cord syndrome in adults with spina bifida occulta. Neurol Res. 2004;26:735–40.
Pang D, Dias MS, Ahab-Barmada M. Split cord malformation: part I. A unified theory of embryogenesis for double spinal cord malformations. Neurosurgery. 1992;31:451–80.
Tortori-Donati P, Rossi A, Cama A. Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology. 2000;42:471–91.
Yamada S, Knerium DS, Mandybur GM, Schultz RL, Yamada BS. Pathophysiology of tethered cord syndrome and other complex factors. Neurol Res. 2004;26:722–6.
Iskandar BJ, Fulmer BB, Hadley MN, Oakes WJ. Congenital tethered spinal cord syndrome in adults. Neurosurg Focus. 2001;10(1):E7.
Solmaz I, Izci Y, Albayrak B, Cetinalp E, Kural C, Sengul G, Gocmez C, Pusat S, Tuzun Y. Tethered cord syndrome in childhood special emphasis in the surgical technique and review of the literature with our experience. Turk Neurosurg. 2011;21(4):516–21.
Akay KM, Izci Y, Baysefer A, Timurkaynak E. Split cord malformation in adults. Neurosurg Rev. 2004;27:99–105.
Bowman RW, Mohan A, Ito J, Seibly JM, Mcbone DG. Tethered cord release: a long-term study in 114 patients. J Neurosurg Pediatr. 2009;3:181–7.
Fehlings MG, Arvin B. Editorial. Recurrent tethered cord syndrome: a novel approach for a difficult surgical condition? J Neurosurg Spine. 2009;10:275–7.
Cochrane DD. Cord untethering for lipomyelomeningocele: expectation after surgery. Neurosurg Focus. 2007;23(2):E9.
Warder DE. Tethered cord syndrome and occult spinal dysraphism. Neurosurg Focus. 2001;10(1.):Article 1):1–9.
Skin P, Halpin RJ, Ganju A, Liu JC. Management of recurrent adult tethered cord syndrome. Neurosurg Focus. 2010;29(1):E5.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Abdallah, A. (2019). Adult Presentations/Outcomes of Occult Spinal Dysraphism. In: Tubbs, R., Oskouian, R., Blount, J., Oakes, W. (eds) Occult Spinal Dysraphism. Springer, Cham. https://doi.org/10.1007/978-3-030-10994-3_7
Download citation
DOI: https://doi.org/10.1007/978-3-030-10994-3_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-10993-6
Online ISBN: 978-3-030-10994-3
eBook Packages: MedicineMedicine (R0)