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  • Pediatric Tethered Cord

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    Pediatric tethered cord syndrome is caused by excessive tension on the spinal cord due to a variety of pathologies. It can be diagnosed at birth by skin stigmas or later due to neurological, orthopedic, or urological symptoms. Failure of primary neurulation during development can result in tethering, with symptoms including lower extremity dysfunction, orthopedic deformities, and urinary issues in up to 75% of cases. Patients should undergo urodynamics testing to evaluate bladder function pre- and post-operatively, and tethered cord syndrome is classified into subgroups based on the origin of the tethering pathology.

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    Tethered Cord Syndrome

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    Pediatric tethered cord syndrome is caused by excessive tension on the spinal cord due to a variety of pathologies. It can be diagnosed at birth by skin stigmas or later due to neurological, orthopedic, or urological symptoms. Failure of primary neurulation during development can result in tethering, with symptoms including lower extremity dysfunction, orthopedic deformities, and urinary issues in up to 75% of cases. Patients should undergo urodynamics testing to evaluate bladder function pre- and post-operatively, and tethered cord syndrome is classified into subgroups based on the origin of the tethering pathology.

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    © All Rights Reserved
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    5 views11 pages

    Pediatric Tethered Cord

    Uploaded by

    dosy
    Pediatric tethered cord syndrome is caused by excessive tension on the spinal cord due to a variety of pathologies. It can be diagnosed at birth by skin stigmas or later due to neurological, orthopedic, or urological symptoms. Failure of primary neurulation during development can result in tethering, with symptoms including lower extremity dysfunction, orthopedic deformities, and urinary issues in up to 75% of cases. Patients should undergo urodynamics testing to evaluate bladder function pre- and post-operatively, and tethered cord syndrome is classified into subgroups based on the origin of the tethering pathology.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 11

    Pediatric Tethered Cord

    Syndrome
    Definiton
    • Any pathology causing excessive tension on
    spinal cord
    • Wide variety of pathologies
    • Dx at birth: skin stigmatas
    • Dx later due to neurological orthopedic
    urological
    • Hoffman 1976
    Hoffman HJ, Hendrick EB, Humphreys RP
    The tethered spinal cord: its protean
    manifestations, diagnosis and surgical
    correction.
    Conus Level
    • Conus level: L‐1/L‐2
    • Inferior margin of L‐2:
    • Low‐lying conus medullaris : its tip is located
    below the
    • L‐2 vertebral level
    Failure of Primary Neurulation

    • Non‐disjunction: open NTD, mm


    • Premature disjunction: lipomm
    • Focal disjunction failure: dermal sinus tract
    Symptoms

    • Wide variety of pathologies


    • Signs and symptoms caused by excessive tension
    on spinal cord
    • Neurological dysfunction:
    LE motor deficits, spasticity
    Sensory deficits
    • Orthopedic deformities:
    Contractures
    Scoliosis
    • GU/GI: Urinary dysfunction/sphincter dysfunction
    Urinary Dysfunction
    • Incontinence in population: 10%
    • Associated with TCS… up to 75% dysfuction
    • Most common finding: detrusor hyperreflexia
    • Importance pre and postop urodynamics
    • Formal urodynamics testing recommended in
    all TCS patients
    Classification

    Subgroups based on the origin of tethering


    1. Postrepair mm
    2. Terminal filum lipoma & tight terminal filum
    3. Lipomm & conus lipoma
    4. SCM (Diastematomyelia)

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