Split cord malformation and tethered cord syndrome: case series with long-term follow-up and literature review
| Autor: | Andrew J. Kobets, Mari L. Groves, George I. Jallo, Alan R. Cohen, Jeffrey Oliver |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cord business.industry General Medicine Scoliosis Lipoma medicine.disease Symptomatic relief Surgery Conus medullaris 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health medicine Intractable pain Neurology (clinical) Neurosurgery business 030217 neurology & neurosurgery Diastematomyelia |
| Zdroj: | Child's Nervous System. 37:1301-1306 |
| ISSN: | 1433-0350 0256-7040 |
| Popis: | To date, the description of the natural course of concurrent tethered cord syndrome with a low-lying conus medullaris and split cord malformation is lacking in the literature. We report a cohort of adult and pediatric patients with concurrent malformations and long-term follow-up. Patients with concurrent diagnoses of split cord malformation and tethered cord (radiographic evidence supporting clinical symptomatology) were identified between 2000 and 2020. Patients without sufficient documentation or at least 6-month follow-up were excluded. Nine patients were identified with an average of 8.9 years follow-up (range 2–31 years). The most common symptoms were radiating leg pain and lower extremity paresthesias, occurring in 44% of patients; and bladder/bowel dysfunction, worsening scoliosis, and acute motor deterioration were less common. Two patients were successfully treated conservatively for mild leg pain and paresthesias. For those who underwent surgery, all experienced symptomatic relief upon first follow-up. Two had late symptomatic recurrence; one 4 and 8 years after initial surgery; and the other, 11, 26, and 31 years after initial surgery. The rarity of concurrent split cord and tethered cord syndrome with a low-lying conus makes management difficult to formulate. This series supplements our knowledge of the long-term outcomes and lessons learned from the management of these patients. Approximately 25% of patients were managed conservatively and had symptomatic improvement. For surgically managed patients, with intractable pain or worsening neurological function, symptoms can still recur over a decade after intervention. Reoperation, however, can still be beneficial, can provide years of relief, and should be considered. |
| Databáze: | OpenAIRE |
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