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Occult tethered cord syndrome: a survey of practice patterns.
J Neurosurg. 2006 May; 104(5 Suppl):309-13.JN

Abstract

OBJECT

Tethered cord syndrome (TCS) is associated with a number of congenital anomalies involving early development of the spinal cord. These include myelomeningocele, spinal cord lipoma, low-lying conus medullaris, and a fibrofatty terminal filum. Occult TCS occurs in patients when clinical features indicate a TCS but the typical anatomical abnormalities are lacking. It is controversial whether surgical release of the terminal filum leads to clinical improvement in a patient who does not have a previously identified anatomical abnormality. To assess the clinical standard used by practicing pediatric neurosurgeons, a practice survey was conducted at the 2004 Annual Meeting of the Joint Section for Pediatric Neurological Surgery of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

METHODS

The survey examined clinical decision making for a same-case scenario with differing appearance on imaging studies. There was a clear consensus regarding diagnosis and treatment in the patient with symptoms, a low-lying conus medullaris, and a fatty terminal filum. The vast majority of respondents (85%) favored surgical untethering for this patient. A majority of respondents (67%) also favored treatment for the patient having symptoms and a fatty terminal filum. There was, however, significant disagreement regarding the diagnosis and treatment of disease in one patient with symptoms and an inconclusive magnetic resonance imaging study. Some respondents clearly favored surgery, whereas others believed that this patient did not meet the diagnostic criteria for TCS.

CONCLUSIONS

The results of this survey support the development of a randomized clinical trial to address the benefit of surgery for occult TCS.

Authors+Show Affiliations

Division of Neurosurgery, British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16848087

Citation

Steinbok, Paul, et al. "Occult Tethered Cord Syndrome: a Survey of Practice Patterns." Journal of Neurosurgery, vol. 104, no. 5 Suppl, 2006, pp. 309-13.
Steinbok P, Garton HJ, Gupta N. Occult tethered cord syndrome: a survey of practice patterns. J Neurosurg. 2006;104(5 Suppl):309-13.
Steinbok, P., Garton, H. J., & Gupta, N. (2006). Occult tethered cord syndrome: a survey of practice patterns. Journal of Neurosurgery, 104(5 Suppl), 309-13.
Steinbok P, Garton HJ, Gupta N. Occult Tethered Cord Syndrome: a Survey of Practice Patterns. J Neurosurg. 2006;104(5 Suppl):309-13. PubMed PMID: 16848087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Occult tethered cord syndrome: a survey of practice patterns. AU - Steinbok,Paul, AU - Garton,Hugh J L, AU - Gupta,Nalin, PY - 2006/7/20/pubmed PY - 2006/8/25/medline PY - 2006/7/20/entrez SP - 309 EP - 13 JF - Journal of neurosurgery JO - J Neurosurg VL - 104 IS - 5 Suppl N2 - OBJECT: Tethered cord syndrome (TCS) is associated with a number of congenital anomalies involving early development of the spinal cord. These include myelomeningocele, spinal cord lipoma, low-lying conus medullaris, and a fibrofatty terminal filum. Occult TCS occurs in patients when clinical features indicate a TCS but the typical anatomical abnormalities are lacking. It is controversial whether surgical release of the terminal filum leads to clinical improvement in a patient who does not have a previously identified anatomical abnormality. To assess the clinical standard used by practicing pediatric neurosurgeons, a practice survey was conducted at the 2004 Annual Meeting of the Joint Section for Pediatric Neurological Surgery of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. METHODS: The survey examined clinical decision making for a same-case scenario with differing appearance on imaging studies. There was a clear consensus regarding diagnosis and treatment in the patient with symptoms, a low-lying conus medullaris, and a fatty terminal filum. The vast majority of respondents (85%) favored surgical untethering for this patient. A majority of respondents (67%) also favored treatment for the patient having symptoms and a fatty terminal filum. There was, however, significant disagreement regarding the diagnosis and treatment of disease in one patient with symptoms and an inconclusive magnetic resonance imaging study. Some respondents clearly favored surgery, whereas others believed that this patient did not meet the diagnostic criteria for TCS. CONCLUSIONS: The results of this survey support the development of a randomized clinical trial to address the benefit of surgery for occult TCS. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/16848087/Occult_tethered_cord_syndrome:_a_survey_of_practice_patterns_ L2 - https://thejns.org/doi/10.3171/ped.2006.104.5.309 DB - PRIME DP - Unbound Medicine ER -