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Occult tethered cord syndrome: the case for surgery.
J Neurosurg. 2006 May; 104(5 Suppl):302-4.JN

Abstract

OBJECT

Controversy exists regarding proper indications for surgical lysis of the terminal filum in children with voiding dysfunction and tethered spinal cord. Recently, surgery has been offered to children who have a normally positioned conus medullaris and no terminal filum abnormality visible on 1.5-tesla magnetic resonance images (referred to as minimal or occult tethered cord syndrome [TCS]). The author evaluates existing clinical and scientific evidence relevant to this controversy.

METHODS

Five retrospective, observational, noncontrolled studies of surgical terminal filum lysis for occult TCS in children were identified. Two further studies in which the authors reported surgical results in children with a normal-level conus medullaris were also identified.

CONCLUSIONS

These studies document encouraging clinical outcomes following surgery. Clinicopathological evidence suggests that occult TCS may result from radiographically occult structural abnormalities of the terminal filum. Although a preponderance of Class III clinical evidence supports the use of surgical filum lysis to treat occult TCS, no Class I or II evidence exists. Clinical practice varies; therefore, performance of a prospective randomized clinical trial of surgical terminal filum lysis for the treatment of occult TCS is advocated.

Authors+Show Affiliations

Division of Pediatric Neurosurgery, Oregon Health & Science University, Portland, Oregon 97239, USA. seldenn@ohsu.edu

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

16848085

Citation

Selden, Nathan R.. "Occult Tethered Cord Syndrome: the Case for Surgery." Journal of Neurosurgery, vol. 104, no. 5 Suppl, 2006, pp. 302-4.
Selden NR. Occult tethered cord syndrome: the case for surgery. J Neurosurg. 2006;104(5 Suppl):302-4.
Selden, N. R. (2006). Occult tethered cord syndrome: the case for surgery. Journal of Neurosurgery, 104(5 Suppl), 302-4.
Selden NR. Occult Tethered Cord Syndrome: the Case for Surgery. J Neurosurg. 2006;104(5 Suppl):302-4. PubMed PMID: 16848085.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Occult tethered cord syndrome: the case for surgery. A1 - Selden,Nathan R, PY - 2006/7/20/pubmed PY - 2006/8/25/medline PY - 2006/7/20/entrez SP - 302 EP - 4 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 104 IS - 5 Suppl N2 - OBJECT: Controversy exists regarding proper indications for surgical lysis of the terminal filum in children with voiding dysfunction and tethered spinal cord. Recently, surgery has been offered to children who have a normally positioned conus medullaris and no terminal filum abnormality visible on 1.5-tesla magnetic resonance images (referred to as minimal or occult tethered cord syndrome [TCS]). The author evaluates existing clinical and scientific evidence relevant to this controversy. METHODS: Five retrospective, observational, noncontrolled studies of surgical terminal filum lysis for occult TCS in children were identified. Two further studies in which the authors reported surgical results in children with a normal-level conus medullaris were also identified. CONCLUSIONS: These studies document encouraging clinical outcomes following surgery. Clinicopathological evidence suggests that occult TCS may result from radiographically occult structural abnormalities of the terminal filum. Although a preponderance of Class III clinical evidence supports the use of surgical filum lysis to treat occult TCS, no Class I or II evidence exists. Clinical practice varies; therefore, performance of a prospective randomized clinical trial of surgical terminal filum lysis for the treatment of occult TCS is advocated. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/16848085/Occult_tethered_cord_syndrome:_the_case_for_surgery_ L2 - https://thejns.org/doi/10.3171/ped.2006.104.5.302 DB - PRIME DP - Unbound Medicine ER -