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Year:: 2019
Contributor:: Hagan, Matthew (Author); Leary, Owen (Author); McElroy, Abigail (Author); Liu, David (Author); Fridley, Jared (Author); Telfeian, Albert (Author); Carayannopoulos, Alexios (Author); Donahue, John (Author); Gokaslan, Ziya (Author); Oyelese, Adetokunbo (Author); Klinge, Petra (Author); Brown University. Alpert Medical School. Scholarly Concentration Program. Non-Scholarly Concentrator (research program)
Subject:: Spinal cord; Pathology; Electron microscopy

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Abstract:: Introduction: Pathophysiology and rationale for surgery in adult-onset tethered cord syndrome (ATCS) are controversial. In this population, comorbid degenerative spinal disease (DSD) and prior trauma may sometimes distract from radiographic evidence of tethered cord, i.e. low-lying conus (LLC), fatty filum terminale (FFT) or filum lipoma (FL). We present a single-center case series detailing symptoms, radiographic characteristics, pathology, and outcomes in patients that underwent surgical detethering for ATCS. Methods: Electronic medical records of consecutive patients (2013–2019) who underwent surgical detethering for symptomatic and radiographic evidence of ATCS were retrospectively reviewed. Medical history, presenting symptoms, MRI reports, and post-operative outcome data were reported using descriptive statistics. Filum terminale specimens were sectioned and analyzed using routine histology and electron microscopy. Correlation of pre-operative and pathologic characteristics with outcome were assessed using regression analysis. Results: 49 patients (mean age 47.9±17.6 years) diagnosed with ATCS met inclusion criteria. From baseline to 1-month post-op, the proportion of patients presenting with neurologic symptoms (e.g. leg pain) decreased from 100% to 77.8% (p<0.001), orthopedic symptoms (e.g. back pain) from 100% to 57.8% (p<0.001), urinary symptoms from 79.6% to 26.7% (p<0.001), and bowel symptoms from 34.7% to 6.7% (p<0.001). Differences remained significantly lower at 3-months and 12-months post-operatively (p<0.05). On MRI, LLC was seen in 75.5% of patients, FFT in 8.2%, and FL in 69.4%. DSD was diagnosed in 87.7% of patients, and prior trauma was reported by 34.7%. Neither DSD nor prior trauma were statistically correlated with surgical outcome. Higher presence of adipose and neuronal elements on FT pathology were associated with 3-month post-operative symptomatic improvement. Conclusions: Surgical intervention resulted in favorable symptom improvement for many patients with evidence of ATCS, even in the presence of comorbid degenerative pathology. The correlation of clinical outcome with filum adipose content corresponds to previous findings in pediatric TCS.
Notes:: Scholarly concentration: Non-Scholarly Concentrator

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Hagan, Matthew, Leary, Owen, McElroy, Abigail, et al., "Adult Onset Tethered Cord Syndrome: Spinal Pathology, Clinical and Histological Characteristics and Post-Operative Outcomes" (2019). Warren Alpert Medical School Academic Symposium. Brown Digital Repository. Brown University Library. https://repository.library.brown.edu/studio/item/bdr:957138/

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Warren Alpert Medical School Academic Symposium

The Warren Alpert Medical School Academic Symposium is an annual event at Warren Alpert Medical School of Brown University that provides Year II medical students a venue to present their summer research in a poster format. Participation in the Symposium …
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Adult Onset Tethered Cord Syndrome: Spinal Pathology, Clinical and Histological Characteristics and Post-Operative Outcomes