Management of Tethered Cord Syndrome in Adults: Experience of 23 Cases.

AIM: Tethered cord syndrome (TCS) is rarely diagnosed in adults. It is a complex clinicopathological entity that remains poorly understood. In this study, clinical outcomes of 23 consecutive congenital TCSs diagnosed in adults have been evaluated to establish a standard approach to treat congenital TCS diagnosed in adults. MATERIAL AND METHODS: Medical records were retrospectively reviewed in 73 cases of TCS who were underwent surgery in our hospital, between 2005 and 2014. Cases which diagnosed and treated surgically in adults (patient age > 18 years) were included in this study. RESULTS: Twenty-three adult cases of TCSs were treated surgically and 15 of them were female and 8 were male. The mean age was 30.3±10.7 years. The mean follow-up period was 75.6±40.5 months. The most common complaint was low back pain. The most common findings in the neurological examinations were muscular weakness and urinary incontinence. The most common co-malformations were diastematomyelia and vertebral fusion anomalies. Conus medullaris was mostly terminated at the L5 level. Detethering procedure was carried out in 87% of patients and bony septum resection without detethering was applied in 13%. Laminoplasty was performed only in 39.1%. 60.9% of patients were recovered good. 34.8% of patients were improved. The most common complication was cerebrospinal fluid leakage. CONCLUSION: Despite the good results obtained in our surgical interventions for symptomatic TCS in adults, tethered cord releasing is complex procedure and has serious complications. Therefore, it is suggested to plan surgery according to symptoms emphasized with full neurological examination, craniospinal imaging and urodynamic tests.

Long-term Surgical Outcomes of Spinal Schwannomas: Retrospective Analysis of 49 Consecutive Cases.

AIM: Spinal schwannomas (SS) represent the most common intradural extramedullary lesions, accounting for approximately 24% of all nerve sheath tumors in adults. Schwannomas have infrequent, but existent possibility of malignancy. In this study, long-term outcomes of 49 consecutive SS have been presented. MATERIAL AND METHODS: Medical records were retrospectively reviewed in 371 cases of spinal tumors who underwent surgery between the years 2005 and 2014. Cases confirmed as schwannoma histopathologically were included in this study. Patients" complaints, localizations, recurrence rate and complications were evaluated. RESULTS: Forty-nine cases were detected in 47 (26 female, 21 male) patients. The mean age was 45.8±13.7 years. The mean follow-up period was 61.4±21.5 months. The most common complaint was local pain. Eleven were cervical, ten thoracic, twentyfour lumbar, and four in the sacral spine. Thirty-three cases were intradural-extramedullary, fifteen cases were the extradural type, and one case was the extra-intradural type. Recurrence rate was 4.08%. Gross-total resection (GTR) was achieved in forty-seven patients. The most common complications were surgical site infection and intraoperative instability that were seen in three patients each. Posterior instrumentation was performed in two patients. CONCLUSION: SS is mostly benign and intradural-extramedullary. To treat patients with SS, there is no need for adjuvant treatments; GTR with preservation of neurological functions is the best treatment to relieve patients" complaints and to reduce the recurrence rate of SS. To avoid serious complications, we recommend intraoperative neurophysiological monitoring and laminoplasty, especially in young patients. Dumbbell SS may require extensive bone resection. Posterior instrumentation can be used if instability occurs.