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The value of postoperative MR in tethered cord: a review of 140 cases

  • Controversy in Neurosurgery
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A Commentary to this article was published on 29 September 2011

A Commentary to this article was published on 29 September 2011

A Commentary to this article was published on 29 September 2011

A Commentary to this article was published on 29 September 2011

A Commentary to this article was published on 29 September 2011

A Commentary to this article was published on 29 September 2011

A Commentary to this article was published on 29 September 2011

Abstract

Purpose

This study aimed to determine the justification for routine postoperative MRI (POMR) following surgical release of tethered cord (TC) given that an MR, in this situation, mostly serves as a baseline and rarely has immediate clinical implications. Furthermore, later in the course of the disease, the presence of retethering is mostly assessed by clinical parameters, rather than imaging.

Methods

A single-center retrospective review of patients who underwent tethered cord release surgery between the years 1997 and 2009 at the Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Israel was performed. Collected data including basis for diagnosis, pathology, associated clinical and radiologic findings, surgical procedure and outcome, postoperative follow-up and morbidities, and postoperative MRI findings were recorded and analyzed.

Results

One hundred forty patients operated upon between 1997 and 2009 for tethered cord syndrome were reviewed. Routine postoperative MR was performed in all cases 6–18 months after surgery. All cases were fully untethered. MR revealed relevant information in eight cases, two with residual dermoid, and six with significant terminal syrinx. None of these findings led to repeat surgery or special treatment. Retethering operations were performed in two cases in which retethering was diagnosed based on clinical evaluation.

Conclusions

Based on analysis of our series of 140 consecutive patients who all underwent POMR 6–18 months after TC release, we suggest that POMR as routine clinical practice is not justified for uncomplicated cases of TC release. In cases of high risk for retethering, or significant preoperative syrinx or dermoid, POMR is recommended to establish a baseline for future clinical follow-up.

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References

  1. Ben-Sira L, Ponger P, Miller E, Beni-Adani L, Constantini S (2009) Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr 155:864–869

    Article  PubMed  Google Scholar 

  2. Colak A, Pollack IF, Albright AL (1998) Recurrent tethering: a common long-term problem after lipomyelomeningocele repair. Pediatr Neurosurg 29:184–190

    Article  PubMed  CAS  Google Scholar 

  3. Emmez H, Guven C, Kurt G, Kardes O, Dogulu F, Baykaner K (2004) Terminal syringomyelia: is it as innocent as it seems?—Case report. Neurol Med Chir (Tokyo) 44:558–561

    Article  Google Scholar 

  4. Erkan K, Unal F, Kiris T (1999) Terminal syringomyelia in association with the tethered cord syndrome. Neurosurgery 45:1351–1359, discussion 1359–1360

    Article  PubMed  CAS  Google Scholar 

  5. Gan YC, Sgouros S, Walsh AR, Hockley AD (2007) Diastematomyelia in children: treatment outcome and natural history of associated syringomyelia. Childs Nerv Syst 23:515–519

    Article  PubMed  CAS  Google Scholar 

  6. Gupta RK, Sharma A, Jena A, Tyagi G, Prakash B, Khushu S (1990) Magnetic resonance evaluation of spinal dysraphism in children. Childs Nerv Syst 6:161–165

    Article  PubMed  CAS  Google Scholar 

  7. Haro H, Komori H, Okawa A, Kawabata S, Shinomiya K (2004) Long-term outcomes of surgical treatment for tethered cord syndrome. J Spinal Disord Tech 17:16–20

    Article  PubMed  Google Scholar 

  8. Hsu AR, Hou LC, Veeravagu A, Barnes PD, Huhn SL (2009) Resolution of syringomyelia after release of tethered cord. Surg Neurol 72:657–661

    Article  PubMed  Google Scholar 

  9. Iskandar BJ, Oakes WJ, McLaughlin C, Osumi AK, Tien RD (1994) Terminal syringohydromyelia and occult spinal dysraphism. J Neurosurg 81:513–519

    Article  PubMed  CAS  Google Scholar 

  10. Kanev PM, Lemire RJ, Loeser JD, Berger MS (1990) Management and long-term follow-up review of children with lipomyelomeningocele, 1952–1987. J Neurosurg 73:48–52

    Article  PubMed  CAS  Google Scholar 

  11. Lew SM, Kothbauer KF (2007) Tethered cord syndrome: an updated review. Pediatr Neurosurg 43:236–248

    Article  PubMed  Google Scholar 

  12. Meltzer H, James HE, Trauner D, Katz R (1995) Syringomyelia of the distal spinal cord in children. Pediatr Neurosurg 22:248–250

    Article  PubMed  CAS  Google Scholar 

  13. Ng WH, Seow WT (2001) Tethered cord syndrome preceding syrinx formation—serial radiological documentation. Childs Nerv Syst 17:494–496

    Article  PubMed  CAS  Google Scholar 

  14. Ponger P, Ben-Sira L, Beni-Adani L, Steinbok P, Constantini S (2010) International survey on the management of skin stigmata and suspected tethered cord. Childs Nerv Syst 26:1719–1725

    Article  PubMed  Google Scholar 

  15. Sade B, Beni-Adani L, Ben-Sira L, Constantini S (2003) Progression of terminal syrinx in occult spina bifida after untethering. Childs Nerv Syst 19:106–108

    PubMed  CAS  Google Scholar 

  16. Steinbok P, Garton HJ, Gupta N (2006) Occult tethered cord syndrome: a survey of practice patterns. J Neurosurg 104:309–313

    PubMed  Google Scholar 

  17. Terai T, Henmi T, Kanematsu Y, Fujii K, Mishiro T, Sakai T, Sairyo K (2006) Adult onset tethered cord syndrome associated with intradural dermoid cyst. A case report. Spinal Cord 44:260–262

    Article  PubMed  CAS  Google Scholar 

  18. van der Meulen WD, Hoving EW, Staal-Schreinemacher A, Begeer JH (2002) Analysis of different treatment modalities of tethered cord syndrome. Childs Nerv Syst 18:513–517

    Article  PubMed  Google Scholar 

  19. Vernet O, O'Gorman AM, Farmer JP, McPhillips M, Montes JL (1996) Use of the prone position in the MRI evaluation of spinal cord retethering. Pediatr Neurosurg 25:286–294

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizman St, Tel Aviv, 64239, Israel

    P. David Halevi, Suhas Udayakumaran, Liat Ben-Sira & Shlomi Constantini

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  1. P. David Halevi
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  2. Suhas Udayakumaran
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  3. Liat Ben-Sira
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  4. Shlomi Constantini
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Corresponding author

Correspondence to Shlomi Constantini.

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Halevi, P.D., Udayakumaran, S., Ben-Sira, L. et al. The value of postoperative MR in tethered cord: a review of 140 cases. Childs Nerv Syst 27, 2159–2162 (2011). https://doi.org/10.1007/s00381-011-1578-7

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  • DOI: https://doi.org/10.1007/s00381-011-1578-7

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