Congenital tethered cord in adults with concomitant lipoma of filium terminale – case report
Rafał Staszkiewicz 1  
,   Waldemar Och 1  
,   Wiesław Strohm 1  
,   Jan Miodoński 1  
,   Adrian Kotas 2  
,   Wiesław Marcol 3  
 
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1
5th Military Hospital with Polyclinic in Cracow, Poland
2
Department of Neurosurgery, 2nd Voivodeship Specialist Hospital in Jastrzębie Zdrój
3
Department of Physiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
CORRESPONDING AUTHOR
Wiesław Marcol   

Department of Physiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland, ul. Medyków 18, 40-752 Katowice-Ligota
 
Ann. Acad. Med. Siles. 2018;72:230–235
 
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ABSTRACT
Congenital adult tethered cord syndrome (TCS) with accompanying lipoma is a rare disease in adults and difficult to diagnose. Surgical treatment is difficult and can lead to many complications. The authors present a case of a 26-year-old woman with a large filium terminale lipoma and tethered cord at the S2 level. The patient complained of pain in the lumbosacral region of the spine, moderate incontinence, and a right-sided foot drop with impaired sensation. Diagnostics were performed using magnetic resonance imaging (MRI). The patient underwent a surgical procedure untethering the spinal cord with a partial lipoma resection. Microsurgical techniques were used during the procedure and intraoperative neurophysiological monitoring was performed. In the postoperative observation, the pain in the lumbosacral region of the spine was reduced, and some of the sensory disturbances subsided. However, there was no significant improvement in the foot muscle strength. Long-term symptoms such as lumbosacral pain, sensory disturbances and poor urinary incontinence are not characteristic symptoms that clearly indicate tethered cord syndrome. Surgical treatment in this case is a difficult procedure due to the nature and location of changes in the environment of the cauda equina. Another serious problem is identifying the filium terminale. Surgical operation is associated with postoperative fluid fistula with impaired surgical wound healing. The outcome of the surgery is not always satisfactory for the patient, as the only treatment effect can be to stop the progressive neurological symptoms.
 
REFERENCES (16)
1.
Akay K.M., Ersahin Y., Cakir Y. Tethered cord syndrome in adults. Acta Neurochir. 2000; 142(10): 1111–1115.
 
2.
Tubbs R.S., Oakes W.J. Can the conus medullaris in normal position be tethered? Neurol. Res. 2004; 26(7): 727–731, doi: 10.1179/016164104225017910.
 
3.
Kanev P.M., Bierbrauer K.S. Reflections on the natural history of lipomyelomeningocele. Pediatr. Neurosurg. 1995; 22(3): 137–140, doi: 10.1159/000120891.
 
4.
Yamada S., Colohan A.R., Won D.J. Tethered cord syndrome. J. Neurosurg. Spine 2009; 10(1): 71–80, doi: 10.3171/2008.10.SPI15714L.
 
5.
Tubbs R.S., Wellons J.C. Tethered Spinal Cord: Fatty Filum Terminale, Meningocele Manqué, and Dermal Sinus Tracts. In: Youmans Neurological Surgery, 6th Edition. H.R. Winn (Ed.) Elsevier, 2011, pp. 2227–2232.
 
6.
Yamada S., Won D.J., Pezeshkpour G., Yamada B.S., Yamada S.M., Siddiqi J., Zouros A., Colohan A.R. Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg. Focus 2007; 23(2): E6, doi: 10.3171/FOC-07/08/E6.
 
7.
Oakes W.J. The borderlands of the primary tethered cord syndrome. Clin. Neurosurg. 1996; 43: 188–202.
 
8.
Morota N., Ihara S., Ogiwara H. New classification of spinal lipomas based on embryonic stage. J. Neurosurg. Pediatr. 2017; 19(4): 428–439, doi: 10.3171/2016.10.PEDS16247.
 
9.
Gonzalez A.A., Jeyanandarajan D., Hansen C., Zada G., Hsieh P.C. Intraoperative neurophysiological monitoring during spine surgery: a review. Neurosurg. Focus 2009; 27(4): E6, doi: 10.3171/2009.8.FOCUS09150.
 
10.
Chou R., Qaseem A., Snow V., Casey D., Cross J.T. Jr, Shekelle P., Owens D.K. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann. Intern. Med. 2007; 147(7): 478–491.
 
11.
Yamada S., Lonser R.R. Adult tethered cord syndrome. J. Spinal Disord. 2000; 13(4): 319–323.
 
12.
Drake J.M. Surgical management of the tethered spinal cord--walking the fine line. Neurosurg. Focus 2007; 23(2): E4, doi: 10.3171/FOC-07/08/E4.
 
13.
Paradiso G., Lee G.Y., Sarjeant R., Hoang L., Massicotte E.M., Fehlings M.G. Multimodality intraoperative neurophysiologic monitoring findings during surgery for adult tethered cord syndrome: analysis of a series of 44 patients with long-term follow-up. Spine 2006; 31(18): 2095–2102, doi:10.1097/01.brs.0000231687.02271.b6.
 
14.
Pouratian N., Elias W.J., Jane J.A., Phillips L.H., Jane J.A. Sr. Electrophysiologically guided untethering of secondary tethered spinal cord syndrome. Neurosurg. Focus 2010; 29(1): E3, doi: 10.3171/2010.3.FOCUS09299.
 
15.
Sala F., Squintani G., Tramontano V., Arcaro C., Faccioli F., Mazza C. Intraoperative neurophysiology in tethered cord surgery: techniques and results. Childs Nerv. Syst. 2013; 29(9): 1611–1624, doi: 10.1007/s00381-013-2188-3.
 
16.
Husain A.M., Shah D. Prognostic value of neurophysiologic intraoperative monitoring in tethered cord syndrome surgery. J. Clin. Neurophysiol. 2009; 26(4): 244–247, doi: 10.1097/WNP.0b013e3181b2edae.
 
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