Lipomielomeningocele y médula anclada en un neonato: a propósito de un hallazgo cutáneo / Lipomyelomeningocele and tethered cord in neonate: a cutaneous finding / Lipomielomeningocele e medula ancorada em rescem nacido: um achado cutâneo

Introducción: el disrafismo espinal oculto comprende las anomalías congénitas caracterizadas por la fusión incompleta del tubo neural, en las que la lesión se encuentra cubierta por piel sin observarse exposición del tejido nervioso. Existen estigmas cutáneos que se asocian a su presencia, siendo los lipomas congénitos en la línea media posterior altamente sugerentes de lesión espinal. Su principal complicación es la asociación con el síndrome de médula anclada, que puede causar un daño neurológico irreversible. Caso clínico: recién nacida de sexo femenino, durante la exploración en Maternidad detectamos un estigma cutáneo del tipo lipoma en la región sacra sospechoso de disrafismo espinal oculto, confirmándose posteriormente, mediante estudio con ecografía y resonancia magnética, la presencia de lipomielomeningocele y médula anclada. Conclusiones: el reconocimiento de los marcadores cutáneos, que constituyen a veces la única manifestación de la enfermedad en pacientes asintomáticos, posibilitaría un diagnóstico precoz y manejo individualizado con posible corrección quirúrgica según el caso, que podría prevenir el daño neurológico irreversible asociado a la médula anclada.

Introduction: hidden spinal dysraphism involves congenital anomalies characterized by an incomplete fusion of the neural tube, where the lesion is covered by skin and the nervous tissue is not exposed. Some skin stigmas are linked with this spinal injury, mainly congenital lipomas in the posterior midline of the lesion. Hidden spinal dysraphism's main complication could be tethered cord syndrome, which can cause irreversible neurological damage. Clinical case: female newborn showing a lipoma-like skin stigma in the sacral region, looking like hidden spinal dysraphism, which was later confirmed through ultrasound and magnetic resonance imaging, which showed lipomyelomeningocele and a tethered cord. Conclusions: early detection of these skin markers is sometimes the only tool to early diagnosis and personalized treatment in asymptomatic patients. It enables a possible surgical remediation and may prevent the irreversible neurological damage linked to the tethered cord.

Introdução: o disrafismo espinhal oculto envolve anomalias congênitas caracterizadas por uma fusão incompleta do tubo neural, onde a lesão é coberta por pele e o tecido nervoso não fica exposto. Alguns estigmas de pele estão relacionados a essa lesão espinhal, principalmente lipomas congênitos na linha média posterior da lesão. A principal complicação do disrafismo espinhal oculto pode ser a síndrome da medula ancorada, a qual pode causar danos neurológicos irreversíveis. Caso clínico: recém-nascida apresenta estigma cutâneo semelhante a lipoma na região sacral, semelhante a disrafismo espinhal oculto, posteriormente confirmado por ultrassonografia e ressonância magnética, o que evidenciou lipomielomeningocele e medula ancorada. Conclusões: a detecção precoce desses marcadores cutâneos às vezes é a única ferramenta para o diagnóstico precoce e tratamento personalizado em pacientes assintomáticos. Permite uma possível correção cirúrgica e pode prevenir os danos neurológicos irreversíveis ligados à medula ancorada.

Counting of fetal caudal vertebral body ossification center below terminal conus medullaris in the screening of the closed spine bifida and tethered cord syndrome / 中华超声影像学杂志

Objective:To assess the significance of counting the number of caudal vertebral ossification centers (OCN) below fetal terminal conus medullaris in the screening for closed spina bifida and tethered cord syndrome (TCS).Methods:The OCN was counted in 961 normal fetuses(normal group) between 17 and 41 gestational weeks and in 140 fetuses with closed spina bifida or tethered cord syndrome(abnormal group) from Jan.2013 to Dec.2020 in Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Women and Children′s Hospital, School of Medicine, Xiamen University and Maternity and Child Health Care of Guangxi Zhuang Autonomous Region. The OCN was counted in the dorsal mid-sagittal section of fetal caudal spine.The reliability and agreement test were evaluated by intraclass correlation coefficients in another 50 normal fetuses. The OCN was compared between two groups. ROC curve and the cut-off value were constructed and calculated.Results:In normal group, the N increased with the growing of gestational age.In the subgroup of 17-20 weeks, the OCN ranged from 5 to 7 in most fetuses. In the others subgroups, the OCN was equal to or greater than 6 in 99.9% cases and more than 6 in 97.1% cases. In abnormal group, OCN was less than 7 in 93.0% fetuses and less than 6 in 82.8% cases. There were statistical differences between the two groups except for the subgroup of 17-20 gestational weeks( P<0.05). With the cut-off value of 6.5, the specificity and sensitivity were 93.0% and 94.3% respectively for predicting the presence of closed spinal dysraphism or TCS. Conclusions:OCN is a simple way to evaluate the position of conus medullaris and to screen for the skin-covered spine dysraphism or TSC. OCN is more than 6 in most normal fetuses. Further evaluation of spine is required in fetuses with N less than or equal to 6.

Management of pregnancy in a woman with spina bifida: A case report / Philippine Journal of Obstetrics and Gynecology

@#With advancements in corrective surgery for spina bifida since the 1960s, affected women are now reaching adulthood and achieving pregnancies. However, the implications on reproductive health?especially in pregnancy?are rarely studied. We are presenting a case of a woman born with spina bifida who has undergone surgical repair and closure of the defect at 4 years old, as well as surgical management for tethered cord at 13 years old. She lived productively into adulthood, became pregnant and delivered vaginally to a healthy baby despite various obstetrical challenges. In the care for this patient, we faced recurrent urinary tract infections, the risk of preterm delivery and the task of coordinated multidisciplinary care to solve dilemmas in decision making. Through this case report, we were able to share our experience, explore the most recent evidence to support our clinical decisions and hopefully serve as a basis for future clinical practice recommendations.

Clinical study of 21 cases of sacral cysts containing fila terminale / 北京大学学报(医学版)

OBJECTIVE@#To summarize the characteristics of sacral cysts containing fila terminale and to explore the surgical treatment methods.@*METHODS@#The clinical features, imaging characteristics and surgical methods of 21 cases of sacral cysts containing fila terminale from July 2010 to March 2017 were reviewed and analyzed. Lumbosacral and perineal pain, weakness of the lower limbs and bladder and bowel dysfunction were the common clinical symptoms. MRI showed that the cysts located in the sacral canal. The lower T1 and higher T2 signals were found on MRI. There were fila terminale within the cysts which tethered the spinal cord. No enhancement was visible within the lesion. The key steps of operation included the resection of the cyst wall, the cutting off of the fila terminale, the release of the tethered cord and the reconstruction of the cisterna terminalis.@*RESULTS@#The total and subtotal resections of cyst walls were achieved in 14 and 7 cases, respectively. The fila terminales were separated and cut off in all the cases, and the tethered cords were released completely. The reconstructions of the cisterna terminalis were accomplished in all the cases. There was no new-onset dysfunction except for 7 cases of mild numbness around anus postoperatively. Pathological examinations confirmed that the cyst wall was fibrous connective tissue, and hyperplasia of fibrous tissue and/or adipose tissue was found within the thickened fila terminale. The lumbosacral and perineal pain disappeared. The weakness of the lower extremities and the bladder and bowel dysfunction gradually improved. The period of follow-up ranged from 3 months to 7 years (average: 2.25 years). The spinal function of all the patients restored to McCormick grade Ⅰ. Only 1 case encountered recurrence of cyst.@*CONCLUSION@#The sacral cysts containing fila terminale are rare. The common symptoms include lumbosacral and perineal pain and symptoms of tethered cord. MRI is helpful to the diagnosis, which shows the signal of cerebrospinal fluid and the fila terminale in the cyst as well as tlow-placed conus medullaris. Microsurgery should remove the cyst wall, cut off the fila terminale, release the tethered cord and reconstruct the cisterna terminalis.

Médula espinal amarrada. Reporte de caso / Case Report: Tethered cord syndrome

We present the case of a 31-year-old patient recent diagnosed with tethered cord syndrome, by MRI, before urgent caesarian section. The image shows the conus medullaris in a low location, reaching L5-S1, which could lead to potential neurological damage if it hadn't been diagnosed. Tethered cord syndrome is a condition in which the spinal cord is enlongated and in a low location, attached to an inelastic structure that holds the conus medullaris, blocking its normal ascension during growth. As a result, the conus medullaris is located below L2 vertebral body, increasing the risk of suffering direct neural damage at spinal anesthesia. Even if direct cord injury can be avoided, the injection of a local anesthetic agent may increase the subarachnoidal preassure leading undirectly to spinal cord damage. The tethered cord is considered to be a contraindication for spinal anesthesia. The incidence of tethered cord is unknown, it can be asymptomatic in adults or present non-specific symptoms, making it difficult to detect before anesthesia. The MRI is the best method for adult diagnosis, allowing us to evaluate the conus medullaris location, injuries and deformations

Presentamos el caso de una paciente de 31 años coordinada para cesárea de urgencia con diagnóstico reciente de médula amarrada (MA) por resonancia magnética. La imagen muestra el cono medular descendido hasta por lo menos L5-S1, exponiéndola a un potencial daño neurológico de no contar con el diagnóstico. Médula amarrada es una condición en la cual la médula espinal se encuentra estirada y descendida por una estructura inelástica que amarra el cono medular, evitando su normal ascenso durante el crecimiento. Como resultado, el cono medular se encuentra por debajo del cuerpo de L2, incrementando el riesgo de lesión directa con la aguja de raquianestesia. Incluso en aquellos pacientes en que la lesión directa no se produce, la inyección del anestésico local puede aumentar la presión subaracnoidea pudiendo provocar una lesión indirecta. La MA es considerada una contraindicación para la anestesia raquídea. La incidencia de MA se desconoce, en adultos puede ser asintomática o presentar síntomas inespecíficos dificultando su diagnóstico preoperatorio. La RNM es el método de elección para el diagnóstico en adultos, permitiéndonos valorar la localización del cono medular, lesiones y malformaciones En neonatos la ultrasonografía puede ser también de utilidad para el diagnóstico.

The new approach in the location of the fetal conus medullaris and its application in tethered cord syndrome / 中华超声影像学杂志

Objective To evaluate the position of the fetal conus medullaris during pregnancy and its value in detecting tethered cord syndrome(TCS). Methods Nine hundred and seventy-four normal fetuses and 46 fetuses with TCS between 15 and 41 weeks gestation were involved in the study.Parameters D 1 (the distance between the end of the conus medullaris and the caudal edge of last vertebral body ossification center) and D2 (the distance from the end of the conus medullaris to the caudal skin namely the intersection point of the extending line of D1 and the skin) were measured in the caudal midsagittal plane of the spine. Sixty normal fetuses were chosed randomly for interobserver variability.Correlation analysis between these two parameters and gestational age(GA) were conducted and the normal reference value of these parameters were calculated in normal group. The ratios of growth parameters ( Biparietal diameter, Head circumference,Abdominal circumference,Femur length) to D1 and D2 were calculated separately to observe the difference of the ratios between two groups. All the parameters and ratios of normal fetuses were compared with that of TCS cases.Results There was no significant difference in D1 and D2 between two observers.A significant linear correlation between the parameters and GA was found in normal group,linear regression equations were D1=0.251 GA -2.265 cm (R2=0.926,P <0.01) and D2=0.267 GA -1.812 cm(R2=0.928,P <0.01),respectively.D1 and D2 were much lower in normal group than in abnormal group (all P <0.01). The ratios of the growth parameters to D1 and D2 were relatively stable and had statistically differences between two groups in different gestational age. Conclusions The methods that determination of D1 and D2 are simple and feasible,and could help to the prenatal diagnosis of TCS.

Small incision surgical treatment for children with tight filum terminale type of tethered cord syndrome / 局解手术学杂志

Objective To explore the efficacy and complications of small insicion surgical treatment and the routine microscopic surgical treatment for children with tight filum terminale type of tethered cord syndrome.Methods According to the clinical manifestations and imaging findings,a total of 43 children with tethered cord syndrome were classified into two groups.Namely the control group (30 cases) who underwent the routine microscopic surgery and the observation group (13 cases) who underwent the small insicion surgical treatment.The difference including prognosis,complications,hospital stays,size of the wound between the two groups were analyzed.Results The 43 children were followed up for 3 to 24 months with an average of 9 months.The results indicated that the postoperative effective rate of the control group was 93.3％,while it was 100％ in the observation group.The difference between the two groups was not statistically significant(P ＞ 0.05).The rate of complications of the control group was 6.67％ whlie it was 0.00％ in the observation group,and the difference of the two groups was statistically significant(P ＜ 0.05).The difference of hospital stays and the size of the wound between the two groups were statistically significant (P ＜ 0.05).Conclusion The small insicion surgical treatment could guarantee the surgical effect for children with tight filum terminale type of tethered cord syndrome,and it can reduce the surgical trauma,post operation hospitalization duration,incidence of complications and intraoperative scar tissues.

Clinical Observation of Chinese Medicine Fumigation-washing Therapy for Treatment of Talipes Equinus Denervated Ulcer Induced by Tethered Cord Syndrome / 广州中医药大学学报

Objective To investigate the clinical effectiveness and safety of Chinese medicine fumigation-washing therapy in treating talipes equinus denervated ulcer induced by tethered cord syndrome(TCS) . Methods A total of 21 qualified patients were randomized into fumigation-washing group (N=12) and antibiotics group (N=9). Patients of fumigation-washing group were given fumigation-washing therapy with the self-prescribed Chinese medicine, and antibiotics group was given intravenous dripping of sensitive antibiotics. The treatment lasted for 7 continuous days. The clinical efficiency of the two groups was evaluated after treatment, and the period of preparing for surgery was recorded. The changes of ulcer area and ulcer surface exudate volume in the two groups were observed before and after treatment. And the changes in blood routine examination, hepatic and renal function, and immune function of the fumigation-washing group were monitored. Results(1) The total effective rate of fumigation-washing group was 83.3％, and that of the antibiotics group was 77.8％, the difference being insignificant (P>0.05). (2) The ulcer area and ulcer surface exudate volume in both groups were significantly decreased after treatment (P 0.05). (5) The average daily hospitalization fee in the fumigation-washing group was (47.98 ± 5.17) yuan, less than (227.88 ± 43.24) yuan in the antibiotics group, and the difference was significant between the two groups (P < 0.05). Conclusion Chinese medicine fumigation-washing therapy is effective, safe and practical in treating talipes equinus denervated ulcer induced by TCS, and the therapy has the advantages of decreasing exudation, promoting ulcer healing, reducing hospitalization fee, shortening the period of preparing for surgery, and decreasing the incidence of infection.

Three-dimensional ultrasound volume contrast imaging and tomography ultrasound imaging techniques in observing fetal tethered cord / 中国医学影像技术

Objective To evaluate the value of three-dimensional ultrasound volume contrast imaging (VCI) and tomo graphy ultrasound imaging (TUI) techniques in observing fetal spinal conus medullaris (CM) position and lumbar enlargement of spinal cord morphologic changes,for assessment of tethered cord (TC).Methods Totally 17 abnormal fetuses of spinal diseases combined with TC (abnormal group) were examined by three dimensional ultrasound VCI and TUI techniques.The position of CM was recorded,and the transverse and anteroposterior diameters of lumbar enlargement of spinal cord were measured and compared with 300 cases of normal fetuses (normal group).Results As the growth of the gestational age (CA),CM terminal position increased.All the ends of CM located at L3 or L3 above level in normal.The transverse and anteroposterior diameters of lumbar enlargement in normal group showed good linear relationship with GA.Transverse diameter (mm) =0.677+0.147 ×GA (R2 =0.836,P＜0.05),anteroposterior diameter (mm)-0.994+ 0.152× GA (R2=0.894,P＜0.05).Compared with the corresponding GA fetuses in normal group,the anteroposterior diameter of lumbar enlargement decreased in abnormal group (P=0.002),while no statistical difference of the transverse diameter was found between the two groups (P=0.082).Conclusion Position of CM and lumbar enlargement measure ment can provide valuable reference information for clinical prenatal diagnosis of fetal spinal TC.

Estahlishment of a tethered cord syndrome model with neural axial stretch in pig / 第二军医大学学报

Objective To explore a method for establishment of tethered cord syndrome model with neural axial stretch in pig. Methods Eighteen adult pigs were randomized into three groups. Sham group: L1-5 spinal cords were exposed; control group: Li-r, bilateral pedicle screws were placed after exposure of L1-5 spinal cords; and experiment group: L1-5 spinal cords were exposed, then bilateral pedicle screws were placed, and finally L1-5 intervertebral spaces were extended axially, with six in each group. At different time points, the pigs in the three groups were subjected to X ray. hindlimb behaviors, urodynamics, somatosensory evoked potential, laser speckle imaging for blood flow and histopathology examination, and the examination results were compared and analyzed. Results In the sham group and control group, there was no obvious change in L1-5 intervertebral space height, hindlimb motor nerve function scores, urodynamics, somatosensory evoked potentials or laser speckle imaging for blood flow before and after operation; and the spinal cord and nerve structure were normal or nearly normal in the histopathology. In the experiment group, compared with before distraction, Liintervertebral height after distraction was significantly increased, hindlimb motor nerve function score was significantly decreased, latency of P-wave of sematosensory evoked potential was significantly extended and the amplitude was significantly decreased, and blood flow 011 the surface of spinal cord was significantly reduced (P

Research Progress of Model Establishment for Tethered Cord Syndrome (review) / 中国康复理论与实践

@# Tethered cord syndrome (TCS) is a progressive neurodevelopmental disorder. The TCS model was established mainly using physical and chemical Methods and surgery, but remained problems in failing to fully reflect the progressive course of the human TCS. In the future, it may select a single etiological factor to analyze, and gradually add other factors until we have deeper understanding of this disease.

Syringohydromyelia in the primary children tethered cord syndrome:magnetic resonance imaging features and correlation analysis / 实用放射学杂志

Objective To summary MRI features of children syringohydromyelia in primary tethered cord syndrome and analyze the correlation.Methods 84 syringohydromyelia cases were analyzed retrospectively.The imaging features of syringohydromyelia including the location,the size and the shape,the syrinx index and so on were analyzed,and the correlation of syringohydromyelia with various diseases which caused tethered cord syndrome were analyzed simultaneously.Results The central canal of the spinal cord was filiform in 1 5 cases,fine tubular in 21 cases and cystic dilatation in 48 cases.There were no relation to the length and width with the age.There was statistically significance in syrinx index(>40%)with diastematomyelia(P =0.017),and no relation to other types of tethered cord syndrome.Diastematomyelia and myelocele were risk factors for cystic dilatation of syringohydromyelia.Conclusion Diastematomyelia and myelocele have a higher incidence in cystic dilatation of syringohydromyelia than that in other types of tethered cord syndrome,and diastematomyelia is more common in association with bigger syrinx index of syringohydromyelia.

Vertebral and Intraspinal Anomalies in Indian Population with Congenital Scoliosis: A Study of 119 Consecutive Patients

STUDY DESIGN: Retrospective case study by clinical and radiological data analysis. PURPOSE: To analyze different types of vertebral anomalies and the incidence of associated intraspinal anomalies in the Indian population. OVERVIEW OF LITERATURE: This is the largest study of congenital scoliosis and associated intraspinal anomalies in Indian population. Incidence of intraspinal anomaly in this series is 47% which is higher than previous literature. Hemivertebra was the most common anomaly as seen in previous studies. METHODS: A total of 119 patients with congenital scoliosis who underwent surgery between December 2006 and December 2012 were studied. Data was reviewed with medical records, plain radiographs, and magnetic resonance imaging (MRI) scans. RESULTS: Thoracolumbar curve was most common, seen in 43.6% of patients. In addition to scoliotic deformity, kyphosis was seen in 26% of patients. Failure of formation, the most common vertebral anomaly, was seen in 51.2% of patients, failure of segmentation was seen in 19.3% of patients, and there were 29.4% patients having both formation and segmentation anomalies. Hemivertebra was the most common vertebral anomaly seen in 66.3% of patients and for whom 63.2% were in thoracic spine. Intraspinal anomalies were associated with 47% of patients with congenital scoliosis. Tethered cord was the most common intraspinal abnormality and was found in 48.2% patients with intraspinal anomalies. The patients with failure of segmentation and mixed deformities were found to have a significantly higher incidence of intraspinal anomalies (65% and 57%, respectively) than those with failure of formation (34%). Out of 31 patients with kyphotic deformity 29% had intraspinal anomalies, and amongst them tethered cord was the most common anomaly seen in 66% patients. Out of 12 patients with neurocutaneous markers, 83% patients had intraspinal anomaly. CONCLUSIONS: Intraspinal anomalies were seen in 47% of patients with congenital scoliosis in the Indian population. Tethered cord was the most common intraspinal anomaly, seen in 48% cases of congenital scoliosis. Hemivertebra was seen in 66% cases and was the most common vertebral defect. Hence MRI imaging of whole spine should be done in all cases of congenital scoliosis before any surgical intervention. Special attention should be given to physical examination and visualization of any neurocutaneous markers, which are associated with a higher incidence of intraspinal anomalies; absence of a neurocutaneous marker, however, does not rule out intraspinal anomaly.

Variation in Outcome in Tethered Cord Syndrome

STUDY DESIGN: Fifty patients surgically treated for tethered cord syndrome (TCS) were retrospectively studied at Liaquat National Hospital, Karachi from 2010 until 2014. PURPOSE: To assess the common presentations of TCS in our part of the world and the surgical outcome of the different presentations. OVERVIEW OF LITERATURE: TCS is a stretch-induced functional disorder of the spinal cord with its caudal part anchored by an inelastic structure, which results in characteristic symptoms and signs. Due to the variety of lesions and clinical presentations and the absence of high-quality clinical outcome data, the decision regarding treatment is difficult. METHODS: Fifty consecutive patients with TCS were reviewed retrospectively with a follow-up period of 12–48 months. The majority of the patients were 0-15 years of age with the mean age of 4 years. The presenting complaints and the associated pathologies were documented, and the patients were assessed using the new Karachi TCS severity scale for clinical assessment. RESULTS: Eighty five percent of the patients with thickened filum terminale improved. Sixty six percent of the patients with diastematomyelia, 60% with lipoma and only 46% with myelomeningocele showed clinical improvement postoperatively. Sixty two percent of the patients who presented with paraperesis improved following surgery while 37% remained stable and only one patient deteriorated. Back and leg pain improved in 93% of patients and 50% of patients with urinary impairment improved. CONCLUSIONS: Outcome of patients with TCS varies according to pathology and severity of symptoms. Diastematomyelia and thickened filum had the best outcome. The Karachi TCS severity scale is a valid tool for future studies.

Mullerian choristoma in a case of spinal dysraphism.

It is extremely rare to fi nd mullerian choristomas in association with spinal dysraphism, with <10 cases published in English literature. We report a case of heterotopic uterus and fallopian tube-like tissue within a lumbar subcutaneous lipoma associated with spina bifi da and tethered cord. A 21-year-old lady presented with lumbar swelling since birth and dull pain in the lower back. Magnetic resonance imaging showed spina bifi da at level L3 and L4, tethering of the cord and a subcutaneous lipomatous swelling. Biopsy revealed lobules of fi broadipose tissue embedded in which were seen organoid cystic structures containing prominent smooth muscle coats in their wall. These cystic structures were lined by the endometrium and showed fallopian tube-like papillary infoldings. Immunohistochemistry showed estrogen receptor positivity in the epithelium, stroma, and smooth muscles. The epithelial cells were also positive for cancer antigen 125 and cytokeratin 7 while the stromal cells showed CD10 positivity, supporting mullerian derivation. The pathogenesis and differential diagnosis of such lesions is discussed.

Analysis of surgical effect of adult lipomatous tethered cord syndrome / 中国医师进修杂志

Objective To discuss the surgical effect of adult lipomatous tethered cord syndrome (TCS). Methods The clinical data of 29 patients with adult lipomatous TCS were systematically analyzed. Eleven of male and 18 of female,who ranged from 20 to 59 years. All patients were performed filum terminale release and lipoma excision, the clinical outcome after operation was analyzed according to Hoffman grading criteria and visual analog scale (VAS). Results According to Hoffman grading criteria, 9 cases were obviously improved in leg muscle weakness, including 1 case with urination disturbance improved significantly. Also the lower back pain of patients were improved obviously: (2.63 ± 1.30) scores vs. (8.67±0.30) scores, there was significant difference (P<0.05). Conclusions Filum terminale release and lipoma excision can effectively improve the symptom of lower back pain of adult lipomatous TCS patients, meanwhile the symptom of paraparesis can improve appropriate postoperatively. But urinary deficits do not show a significant change.

Diastematomyelia: A Surgical Case with Long-Term Follow-Up

Few reports have described the involvement of syringomyelia associated with diastematomyelia in the etiology of neurological deficits. We reported a case with syringomyelia associated with diastematomyelia. A female patient with diastematomyelia was followed up clinically over 14 years. At the age of 8, she developed clubfoot deformity with neurological deterioration. Motor function of the right peroneus demonstrated grade 2 in manual muscle tests. Continuous intracanial bony septum and double cords with independent double dura were observed at upper thoracic spine. Magnetic resonance imaging revealed a tethering of the spinal cord and syringomyelia distal to the level of diastematomyelia. Extirpation of the osseum septum and duralplasty were performed surgically. She grew without neurological deterioration during 7 years postoperatively. A long-term followed up case with syringomyelia that was possibly secondary to the tethering of the spinal cord associated with diastematomyelia, and effective treatment with extirpation of the osseum septum and duralplasty was described.

Nerve injury in an undiagnosed adult tethered cord syndrome patients following spinal anesthesia: A case report

Spinal anesthesia is a safe and widely used procedure. Spinal cord injury is a rare but serious complication from spinal anesthesia occurs, unexpectedly. Risks of direct neural injury from spinal anesthesia increase in tethered cord syndrome that the spinal cord is tethered by the inelastic structure and is, also, extended to the lower lumbar vertebra. A 52-years-old female patient undergoing anti-incontinence surgery developed neurologic symptoms following spinal anesthesia. The low-lying conus (L5 body level) and tethered cord were found during the assessment of neurological symptoms.

A Tethered Cord with Hemivertebra: A Case Report and Review of Literature

Spinal dysraphisms are defined as open and closed dysraphisms. A hemivertebra is a congenital condition seen in 61% of patients with congenital anomalies. The first report of the excision of a hemivertebra was by Royle in 1928. A sixteen-year-old girl was admitted to our clinic with a congenital stain on the waist and a normal neurological examination. No new cases have been reported in recent literature. Our case, which is also rare, is associated with a tethered cord only and no other congenital abnormalities.

Fully Endoscopic Interlaminar Detethering of Spinal Cord in Tethered Cord Syndrome: A Case Report and Technical Description

A 19-year-old man presented with long lasting significant back and bilateral leg pain, and hypoesthesia on the lateral side of both his thighs for which he had undergone several courses of medication and bouts of physical therapy treatment. His urodynamic parameters were normal and lumbar magnetic resonance imaging (MRI) revealed a low-lying conus at the L2-3 level with a thickened fatty filum, and he was diagnosed as having tethered cord syndrome (TCS). The patient underwent a fully endoscopic detethering through an interlaminar approach with intraoperative neurophysiological monitoring. The thickened filum terminale was located and then the filum was coagulated and cut. The patient showed a significant improvement in his preoperative symptoms, and reported no problems at 2-year follow-up. Detethering of the spinal cord in tethered cord syndrome using a fully endoscopic interlaminar approach provides the advantages of minimal damage to tissues, less postoperative discomfort, early postoperative recovery, and a shorter hospitalization.