The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
George I Jallo - One of the best experts on this subject based on the ideXlab platform.
-
split Cord malformation and Tethered Cord Syndrome case series with long term follow up and literature review
Childs Nervous System, 2021Co-Authors: Andrew J Kobets, George I Jallo, Jeffrey Oliver, Alan B Cohen, Mari L GrovesAbstract: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.
-
Split Cord malformation and Tethered Cord Syndrome: case series with long-term follow-up and literature review
Child's Nervous System, 2020Co-Authors: Andrew J Kobets, George I Jallo, Jeffrey Oliver, Alan Cohen, Mari L GrovesAbstract:Purpose 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. Methods 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. Results 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. Conclusion 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.
-
neurological outcome after surgical management of adult Tethered Cord Syndrome
Journal of Neurosurgery, 2009Co-Authors: Giannina L Garcesambrossi, Matthew J Mcgirt, Roger Samuels, Daniel M Sciubba, Ali Bydon, Ziya L Gokaslan, George I JalloAbstract:Object Although postsurgical neurological outcomes in patients with Tethered Cord Syndrome (TCS) are well known, the rate and development of neurological improvement after first-time Tethered Cord release is incompletely understood. The authors reviewed their institutional experience with the surgical management of adult TCS to assess the time course of symptomatic improvement, and to identify the patient subgroups most likely to experience improvement of motor symptoms. Methods The authors retrospectively reviewed 29 consecutive cases of first-time adult Tethered Cord release. Clinical symptoms of pain and motor and urinary dysfunction were evaluated at 1 and 3 months after surgery, and then every 6 months thereafter. Rates of improvement in pain and motor or urinary dysfunction over time were identified, and presenting factors associated with improvement of motor symptoms were assessed using a multivariate survival analysis (Cox model). Results The mean patient age was 38 ± 13 years. The causes of TCS i...
-
pediatric Tethered Cord Syndrome response of scoliosis to untethering procedures clinical article
Journal of Neurosurgery, 2009Co-Authors: Matthew J Mcgirt, Giannina L Garcesambrossi, Ziya L Gokaslan, Can Solakoglu, Vivek A Mehta, Oren N Gottfried, Amer F Samdani, George I JalloAbstract:Object Tethered Cord Syndrome (TCS) is frequently associated with scoliosis in the pediatric population. Following spinal Cord untethering, many patients continue to experience progression of spinal deformity. However, the incidence rate, time course, and risk factors for scoliosis progression following Tethered Cord release remain unclear. The aim of this study was to determine factors associated with scoliosis progression and whether Tethered Cord release alone would halt curve progression in pediatric TCS. Methods The authors retrospectively reviewed 27 consecutive pediatric cases of spinal Cord untethering associated with scoliosis. The incidence rate and factors associated with scoliosis progression (> 10° increased Cobb angle) after untethering were evaluated using the Kaplan-Meier method. Results The mean age of the patients was 8.9 years. All patients underwent Cord untethering for lower-extremity weakness, back and leg pain, or bowel and bladder changes. Mean ± SD of the Cobb angle at presentatio...
-
incidence of symptomatic retethering after surgical management of pediatric Tethered Cord Syndrome with or without duraplasty
Childs Nervous System, 2009Co-Authors: Roger Samuels, Matthew J Mcgirt, Frank J Attenello, Giannina Garces L Ambrossi, Neil Singh, Can Solakoglu, Jon D Weingart, Benjamin S Carson, George I JalloAbstract:Background Cord retethering and other postoperative complications can occur after the surgical untethering of a first-time symptomatic Tethered Cord. It is unclear if using duraplasty vs. primary dural closure in the initial operation is associated with decreased incidence of either immediate postoperative complications or subsequent symptomatic retethering. It is also unclear if different etiologies are associated with different outcomes after each method of closure. We reviewed our pediatric experience in first-time surgical untethering of symptomatic Tethered Cord Syndrome (TCS) to identify the incidence of postoperative complications and symptomatic retethering after duraplasty vs. primary closure.
Patrick C Hsieh - One of the best experts on this subject based on the ideXlab platform.
-
posterior vertebral column subtraction osteotomy a novel surgical approach for the treatment of multiple recurrences of Tethered Cord Syndrome technical note
Journal of Neurosurgery, 2009Co-Authors: Ryan J. Halpin, Patrick C Hsieh, Stephen L Ondra, Andrew W Grande, Brian A Oshaughnessy, Karin Bierbrauer, Kerry R Crone, Ian SukAbstract:Recurrent Tethered Cord Syndrome (TCS) has been reported to develop in 5–50% of patients following initial spinal Cord detethering operations. Surgery for multiple recurrences of TCS can be difficult and is associated with significant complications. Using a cadaveric Tethered spinal Cord model, Grande and colleagues demonstrated that shortening of the vertebral column by performing a 15–25-mm thoracolumbar osteotomy significantly reduced spinal Cord, lumbosacral nerve root, and terminal filum tension. Based on this cadaveric study, spinal column shortening by a thoracolumbar subtraction osteotomy may be a viable alternative treatment to traditional surgical detethering for multiple recurrences of TCS. In this article, the authors describe the use of posterior vertebral column subtraction osteotomy (PVCSO) for the treatment of 2 patients with multiple recurrences of TCS. Vertebral column resection osteotomy has been widely used in the surgical correction of fixed spinal deformity. The PVCSO is a novel surgical treatment for multiple recur rences of TCS. In such cases, PVCSO may allow surgeons to avoid neural injury by obviating the need for dissection through previously operated sites and may reduce complications related to CSF leakage. The novel use of PVCSO for recurrent TCS is discussed in this report, including surgical considerations and techniques in performing PVCSO. (DOI: 10.3171/2008.10.SPINE08123) key w O r D s • spinal deformity • spinal shortening • subtraction osteotomy • Tethered Cord Syndrome • vertebral column resection
Yasuhisa Tanaka - One of the best experts on this subject based on the ideXlab platform.
-
Spine-shortening osteotomy for patients with Tethered Cord Syndrome caused by lipomyelomeningocele
Journal of neurosurgery. Spine, 2011Co-Authors: Shoichi Kokubun, Hiroshi Ozawa, Toshimi Aizawa, Yasuhisa TanakaAbstract:Object Tethered Cord Syndrome (TCS) is a disorder involving an abnormal stretching of the Tethered spinal Cord caused by several pathological conditions and presents with a variety of neurological symptoms. Untethering (Tethered Cord release) is the gold standard treatment for TCS. However, untethering carries risks of spinal Cord injury and postoperative retethering. To avoid these potential risks, the authors applied spine-shortening osteotomy to adult patients with TCS, and report on the surgical procedure and treatment outcomes. Methods Eight patients with TCS caused by a lipomyelomeningocele were surgically treated by the authors' original procedure of spine-shortening osteotomy. Six patients were male and 2 were females; average age at the time of surgery was 31 years old. Spine-shortening osteotomy was performed at the level of L-1 in all but 2 patients, in whom it was performed at T-12, with spinal fusion between T-12 and L-2 or T-11 and L-1 using a pedicle screw–rod system. The average follow-up ...
Shokei Yamada - One of the best experts on this subject based on the ideXlab platform.
-
intrathecal endoscopy to enhance the diagnosis of Tethered Cord Syndrome
Journal of Neurosurgery, 2010Co-Authors: Kamal R M Woods, Shokei Yamada, Shoko M. Yamada, Austin R T Colohan, Daniel J. WonAbstract:Object Tethered Cord Syndrome (TCS) is being diagnosed in an increasing number of adults and late teens. Before referral to neurosurgeons, however, the majority of patients in this group suffers back and leg pain for a long period without a definitive diagnosis. The diagnostic difficulty derives from 2 factors: the signs and symptoms are subtle and easily overlooked, and the combination of an elongated Cord and a thickened filum is lacking in 65% of patients. When a patient presents with signs and symptoms typical for TCS but demonstrates no elongated Cord or thickened filum on MR imaging, one must search for a more reliable finding to establish a diagnosis of TCS. Based on the authors' earlier surgical experiences, posterior displacement of the terminal filum is consistently found at surgery in all patients with TCS. In previous publications they interpreted this finding as the lower Cord and filum traveling along the concave side of the lumbosacral spinal canal to minimize Cord tension. In the present p...
-
pathophysiology of Tethered Cord Syndrome and similar complex disorders
Neurosurgical Focus, 2007Co-Authors: Shokei Yamada, Brian S. Yamada, Daniel J. Won, Javed Siddiqi, Shoko M. Yamada, Gholam Pezeshkpour, Alexander Zouros, Austin R T ColohanAbstract:Tethered Cord Syndrome (TCS) is a stretch-induced functional disorder of the spinal Cord due to the fact that its caudal portion is anchored by an inelastic structure. The functional lesion of TCS is generally situated in the lumbosacral Cord, and many authors have shown that the Syndrome is reversible via surgery to untether the Cord. To clarify the expressions relevant to TCS, such as "Cord tethering" and "Tethered Cord," the authors have formulated three categories. These categories include cases that show the anatomical appearance of spinal Cord stretching. Among them, Category 1 is isolated to represent the "true TCS." The authors focus their discussion of the pathophysiology of TCS on Category 1 to explain the impaired oxidative metabolism and electrophysiological derangements within the Tethered spinal Cord, which is the primary intrinsic cause of the dysfunction. Furthermore, they extend the discussion to the extrinsic (outside the spinal Cord) factors and other complex conditions that mimic TCS.
-
What is the true Tethered Cord Syndrome
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2007Co-Authors: Shokei Yamada, Daniel J. WonAbstract:Introduction The Tethered Cord Syndrome (TCS) is a stretch-induced functional disorder of the spinal Cord with its caudal part anchored by an inelastic structure.
-
symptomatic protocols for adult Tethered Cord Syndrome
Neurological Research, 2004Co-Authors: Shokei Yamada, Daniel J. Won, Javed Siddiqi, Daniel Kido, Anthony Hadden, John Spitalieri, Bruce A Everett, Chinyere G Obasi, Todd M Goldenberg, Lynton G F GilesAbstract:Diagnosis of Tethered Cord Syndrome (TCS) is complicated because anatomical information is not adequate for this task. For example, recent studies have shown that the combination of an elongated Cord and a thick filum terminale, demonstrated by MRI or at operation, is no longer an essential feature for the diagnosis of TCS. For TCS diagnosis, emphasis should rather be on its characteristic symptomatology and accentuated by postural changes, since TCS is a functional disorder of the lumbosacral spinal Cord. In this report, the authors present the list of signs and symptoms pertinent to TCS in adult and late teenage patients to serve as a diagnostic means.
-
pathophysiology of Tethered Cord Syndrome and other complex factors
Neurological Research, 2004Co-Authors: Shokei Yamada, George Mandybur, David S Knerium, Robert L Schultz, Brian S. YamadaAbstract:There are different interpretations of Tethered Cord Syndrome (TCS) partly due to difficulty in understanding the concept of this Syndrome as a functional disorder not merely based on gross anatomy of congenital anomalies. The essential mechanical factor of Cord tethering is that any of the inelastic structures fastening the caudal end of the spinal Cord produces traction effects on the lumbosacral Cord. The production of such traction is the key to understanding this disorder. In a significant number of patients who present with the typical clinical signs and symptoms of TCS, the diameter of the filum terminale is found within normal limits and the caudal end of the spinal Cord is located in the normal position. Therefore, the definition of TCS requires the demonstration that there is a posterior displacement of the conus and filum by MRI, lack of viscoelasticity by the stretch test of the filum during surgery, and fibrous displacement of glial tissue within the filum by histological studies. This is because there is inconsistency from such studies as ultrasonography, MRI and CT myelography, which attempt to establish the presence of a tight filum terminale. A goal of this article is to provide basic understanding of TCS so that clinicians can use the concept of stretch-induced spinal Cord dysfunction for proper diagnosis and treatment of this disorder.
Cormac O. Maher - One of the best experts on this subject based on the ideXlab platform.
-
the outcome of Tethered Cord release in secondary and multiple repeat Tethered Cord Syndrome clinical article
Journal of Neurosurgery, 2009Co-Authors: Wajd N Alholou, Hugh J. L. Garton, Karin M. Muraszko, Steven R Buchman, Cormac O. MaherAbstract:Object After primary repair of a myelomeningocele or a lipomyelomeningocele, patients can present with symptoms of secondary Tethered Cord Syndrome (TCS). After surgical untethering, a small percentage of these patients can present with multiple repeat TCS. In patients presenting with secondary or multiple repeat TCS, the role as well the expected outcomes of surgical untethering are not well defined. Methods Eighty-four patients who underwent spinal Cord untethering after at least 1 primary repair were retrospectively evaluated using scaled and subjective outcome measures at short-term and long-term follow-up visits. Outcomes were analyzed for predictive measures using multivariate logistic regression. Results Surgical untethering was performed in 66 patients with myelomeningoceles and 18 patients with lipomyelomeningoceles. Fourteen patients underwent multiple repeat spinal Cord untethering. Patients were followed up for an average of 6.2 years. Most patients had stability of function postoperatively. M...
-
Secondary Tethered Cord Syndrome in patients with myelomeningocele.
Journal of pediatric rehabilitation medicine, 2009Co-Authors: Wajd N. Al-holou, Hugh J. L. Garton, Karin M. Muraszko, Cormac O. MaherAbstract:Myelomeningocele is associated with other neurological abnormalities, including hydrocephalus, Chiari II malforma- tions, syringomyelia, and secondary Tethered Cord Syndrome. Tethered Cord Syndrome occurs because of abnormal attachment of the spinal Cord to the caudal dural sac, causing Cord ischemia. Occasionally, symptoms of progressive neurological deteri- oration may occur and can significantly affect the long-term outcome of these patients. Proper management of patients with myelomeningocele requires long-term follow-up and evaluation of signs of neurological deterioration that suggest secondary teth- ered Cord Syndrome. Treatment of these patients may target symptoms, such as urological intervention for bladder dysfunction, or it may target the Tethered Cord itself. Recently, many studies have shown that Tethered Cord release can significantly improve symptoms in these patients.
