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Secondary tethered cord syndrome in adult patients: retethering rates, long-term clinical outcome, and the effect of intraoperative neuromonitoring

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Abstract

Background

The strategy for surgical treatment of tethered cord syndrome in pediatric patients is well established but still bares challenges for adult patients. This retrospective study was performed to assess the surgical outcome of adult patients with a secondary tethered cord syndrome and to evaluate the benefit of intraoperative neuromonitoring.

Methods

Clinical charts of 32 consecutive adult patients who underwent in total 38 surgical untethering procedures at our facility between 2008 and 2018 were retrospectively analyzed. Epidemiological data, MRI scans, and postoperative results were evaluated.

Results

The retethering rate in our patient cohort was 16%. Main complaints were maximal pain (82%), bladder dysfunction (79%), paresthesia (68%), and weakness in the lower extremities (68%). Forty-eight months after surgery, patients’ symptoms generally improved, with an average level of pain of 19.1% (95% CI, 5.7–32.5%), paresthesia 28.7% (95% CI, 12.6–44.8%), weakness in the lower extremities 27.7% (95% CI, 11.1–44.4%), and bladder dysfunction 60.2% (95% CI, 41.6–78.7%). The use of neuromonitoring appears to have a positive impact on patient weakness (OR = 0.07; 95% CI, 0.01–0.68) and paresthesia (OR = 0.03; 95% CI, 0.00–2.18). This benefit is less clear for the retethering rate (OR = 0.45; 95% CI, 0.06–3.26) or the overall clinical outcome (OR = 0.70; 95% CI, 0.14–3.45). The presence of a preoperative Chiari syndrome, syringomyelia, or scoliosis had no relevant influence on the retethering rate.

Conclusions

Our data confirms that untethering surgery in adult patients is relatively safe and has a reasonable chance of clinical improvement of pain, paresthesia, and weakness in the lower extremities. The use of intraoperative monitoring has a positive influence on the improvement of preoperative paralysis.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Tobias Finger, Lukas Depperich, Andreas Schaumann, Matthias Schulz & Ulrich-Wilhelm Thomale

  2. Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Annette Aigner

  3. University Clinic of Anesthesiology and Intensive Care Medicine CCM/CVK, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Simone Wolter

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  1. Tobias Finger
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Correspondence to Tobias Finger.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Finger, T., Aigner, A., Depperich, L. et al. Secondary tethered cord syndrome in adult patients: retethering rates, long-term clinical outcome, and the effect of intraoperative neuromonitoring. Acta Neurochir 162, 2087–2096 (2020). https://doi.org/10.1007/s00701-020-04464-w

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