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Adult Tethered Cord Syndrome: Clinical Considerations and Surgical Management

Lee, Gabriel Y.F. MBBS(Hons), MS, FRACS* †; Gong, Grace W.K. MBBS* †; Paradiso, Guillermo MD, PhD* †; Fehlings, Michael G. MD, PhD, FRCS(C)* †

Original Articles

The adult tethered cord syndrome (TCS) is increasingly well recognized. Owing to the paucity of literature on this subject, its true incidence is not known. In this condition, mechanical “tethering” of the distal spinal cord leads to traction effects on the lumbosacral cord. Etiologies include taut fila terminale, myelomeningocoeles, lipomatous malformations, split cord malformations, and arachnoidal adhesions. Most commonly, patients present with either pain or urologic dysfunction. A majority also have sensori-motor deficits on presentation. Although the pathophysiology of this condition remains poorly understood, microsurgical detethering in carefully selected patients can generally be associated with favourable clinical outcomes and low neurologic complication rates. Surgery should therefore be considered in symptomatic patients with radiologic findings consistent with TCS. In our experience, intraoperative electrophysiologic monitoring is critical in facilitating safe surgery. Previous surgery, particularly in the presence of significant arachnoidal scarring, is regarded as a poor prognostic factor. The optimal management of these patients requires a multidisciplinary approach to address their urologic and orthopedic needs. This paper reviews the embryologic basis, clinical features, surgical management, and outcomes of adult patients with TCS, in the light of published literature.

*Department of Surgery, University of Toronto

Division of Neurosurgery, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada

Reprints: Michael G Fehlings, MD, PhD, Division of Neurosurgery, Spinal Program, Toronto Western Hospital, 399 Bathurst St, 4W 449, Toronto, Ontario M5T 2S8, Canada (e-mail:

Current address: Gabriel Y.F. Lee, Department of Neurosurgery, Yale School of Medicine, New Haven, CN.

Current addresses: Grace W.K. Gong, (1) Yale Centre for Perinatal, Pediatric and Environmental Epidemiology, (2) Department of Allergy and Immunology, Yale School of Medicine, New Haven, CN.

© 2006 Lippincott Williams & Wilkins, Inc.