Unauthorized use of these marks is strictly prohibited. They are the result of incorrect "dysjunction" of the neuroectoderm with incomplete separation of the epidermis (overlying skin) from the neural tube (spinal cord and central nervous system) and . (D) Postoperative sagittal T2-weighted MRI scan obtained 1year after surgery. To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). Patients who underwent surgery for TCS secondary to posttraumatic or postinflammatory conditions were not included in this study. Received 2015 Aug 6; Accepted 2015 Sep 22. tethered cord syndrome, adult, untethering, spine-shortening osteotomy. Short-term results were determined within 3 months of surgery, whereas long-term outcomes (clinical recurrences) were evaluated using Kaplan-Meier statistics. Because the incision is lower on the back around a part of the spine that does Anesthesia, Critical Care & Pain Medicine, Billing, Insurance & Financial Assistance, Unusual dimple or bump near the lower part of the spine. Untethering surgery was performed as a first procedure at our institution, and a massive arachnoidal scar and adhesion were found intraoperatively. He presented with symptoms of lower back pain and legs pain. Search for Similar Articles Depending on your childs age, symptoms of tethered cord syndrome vary. Depending on the type of tethered cord your child has, they may be more at risk for re-tethering (when the spinal cord reattaches to tissue). 5 Tight terminal filum is easy to manage and has excellent outcome, but the complexity of the other pathologies makes it difficult to achieve sufficient clinical results in those cases.7 The authors have no conflicts of interest to disclose. (A) Preoperative lateral radiograph. Overall, it remains unclear which procedure is preferable for TCS in adults: untethering surgery or SSO. This means a shorter, Walk on their own (if appropriate for age), Diazepam (Valium) to prevent muscle spasms. But in Case 3, the paraesthesia and weakness of lower extremities were persistent, and there Tethered cord is usually present at birth . Log in | Become a member | Create an Account If you are unable to log in contact membership@cns.org Apropos of a surgically treated case. Learn about career opportunities, search for positions and apply for a job. Highlight selected keywords in the article text. This condition is In 1891, Jones [14] described what probably is Adult tethered cord syndrome (ATCS) is a rare entity that usually presents with multiple neurological symptoms, including lower extremity pain, backache, lower extremity muscle weakness, and bowel/bladder disturbances. Two groups were distinguished based on the absence (Group A, 43 patients) or presence (Group B, 42 patients) of an associated lipoma or dysraphic cyst (that is, dermoid, epidermoid, or neurenteric cyst). The patient was followed up for 2 years without local recurrence. Patient age ranged from 19 to 75 years. 9 2021 Feb 16;88(3):637-647. doi: 10.1093/neuros/nyaa491. Iskandar BJ, Oakes WJ, McLaughlin C, Osumi AK, Tien RD. [3] Deformity of spinal cord, local tumor compression, scar adhesion, stubby filum terminale, can cause spinal cord fixed to the lesion site, so that the spinal cord cannot move up normally, which is the basis contributing to the incidence of TCS. The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review. Careers. 8 Eleven patients underwent untethering surgery, and 3 patients underwent SSO surgery. He or she can have a pillow but do not raise the head of the bed. Therefore, it is necessary to remove contents within the cyst and to reduce the size of the cyst as far as possible, followed by free cystic wall, and then to minimize the stretching of the nerve tissue. At Mass General, the brightest minds in medicine collaborate on behalf of our patients to bridge innovation science with state-of-the-art clinical medicine. Repeated bladder infections. 13. This allows the covering of the spinal cord to seal so Surgery is the only treatment for tethered cord. 8600 Rockville Pike WebWhat happens after tethered spinal cord surgery? The population consisted of 12 men and 22 women, ranging in age from 18 to 70 years (mean 34 years). This delayed presentation of symptoms is related to the degree of strain placed on the spinal cord over time and may be exacerbated during sports or pregnancy, or may be due to narrowing . 9 WebThe surgery typically takes about four hours, but often takes longer as the neurosurgeon works to remove the adhesion. Yasutsugu Yukawa, none In some children who have tethered cord syndrome, they may lose control of their bladder or bowels. The result may be nerve damage and severe pain. Spinal cord infarction caused by sacral canal epidural steroid injection: A case report. 5 Object: 5 Thoracolumbar surgery for degenerative spine diseases complicated with tethered cord syndrome: A case report. Shinjo T, Hayashi H, Takatani T, Boku E, Nakase H, Kawaguchi M. J Clin Monit Comput. Tethered Cord Syndrome (TCS) is a complex of neurologic symptoms that include pain, incontinence, musculoskeletal deformities, motor weakness, and sensory abnormalities resulting from abnormal stretch placed on the distal spinal cord by congenital or acquired factors. 11 Imaging is very important for the diagnosis of tethered cord. The severity of the condition and the associated signs and symptoms vary from person to person. Back and leg pain improved in 50 and 63% of patients, respectively. This causes extra stress on the nerves and can cause a range of symptoms known as tethered cord syndrome. Recovery was mostly seen in infants and only in one older child. In our study, in patients with severe Hoffman grading and without satisfied remission of symptoms, there were tendencies of longer medical history, more complications, and complicated symptoms; and for patients with relatively short medical history, Hoffman grading was shown to be mild and postoperative symptoms were improved obviously, which were similar with the above conclusions. In syringomyelia, the watery liquid known as . So for you to be re-tethered isn't because there may have been a misstake made during the first surgery, but because your body produced more scarring that caused the cord to reattach itself. Although it was difficult to compare clinical outcomes due to the small numbers of patients and heterogeneity, SSO might be preferable for improving the symptoms in adult TCS after considering these baseline differences. 8 Lee G Y, Paradiso G, Tator C H, Gentili F, Massicotte E M, Fehlings M G. Surgical management of tethered cord syndrome in adults: indications, techniques, and long-term outcomes in 60 patients. Surgery in adult patients with a tethered cord syndrome should be reserved for those with symptoms. According to Hoffman grading system, the neurologic symptoms were improved in 22 patients (27%) and stabilized in 60 patients (73%). Neurophysiologic intraoperative monitoring is when doctors place electrodes (wires with a sticker on one end) on your childs head, arms and legs. Shukla M, Sardhara J, Sahu RN, Sharma P, Behari S, Jaiswal AK, Srivastava AK, Mehrotra A, Das KK, Bhaisora KS. As first-line treatment, patients presenting with TCS typically undergo direct spinal cord untethering, often as young children or infants. The patient with symptoms following resection of a lipomyelomeningocele: do increases in the lumbosacral angle indicate a tethered spinal cord? Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work. The severity of the condition and the associated signs and symptoms vary from person to person. Chapman P H. Congenital intraspinal lipomas: anatomic considerations and surgical treatment. Note: Results are the number of patients with improvement/the number of patients with each symptom preoperatively. Application of microsurgical technique for intraspinal lipoma tethered cord syndrome: report of 611 cases. Weakness or numbness in the legs. You may be trying to access this site from a secured browser on the server. [7] Significantly different from children with TCS, there was also the existence of incentives in adult patients with TCS, such as hip hyperflexion due to high falling injury, lithotomy position delivery, long-time sitting causing over stretching of the spinal cord, all of which might evoke the development of TCS.[8]. 8 He underwent SSO 1.5 years after untethering surgery. Recovery from the surgery is one to two weeks of . 2015-1002-02-09; grant recipient: XK). 12 Treatment of TCS in adults is challenging because these malformations are rare, and adults may present with degenerative changes.9 Moreover, many adults with TCS have undergone previous surgery for myelomeningocele repair or untethering in childhood, which further complicates treatment.7, Untethering surgery has been commonly performed in the management of TCS in adults and children.7 However, neurologic recovery with regard to pain and neurologic deficit shows great variation, with improvement rates ranging from 0 to 100%.1 Changes of symptoms were associated with the course of disease; patients with relatively shorter disease course were shown to have a mild Hoffman grading, whereas patients with relatively longer disease course were indicated to have a severe Hoffman grading. Analysis was performed according to Hoffman grading system. Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients. Pathology and treatment of tethered cord syndrome with lipoma. . 2012 Sep;17(3):199-211. doi: 10.3171/2012.5.SPINE11904. In the early stage of embryo, spinal cord and vertebral canal were roughly equal, but in the later development process, bony spinal growth were indicated to be faster, which was out of synchronization with the growth of spinal cord. You may search for similar articles that contain these same keywords or you may Reduction of caudal traction force using dural sac opening rather than spinal cord detethering for tethered cord syndrome caused by lipomyelomeningocele: a case report. Log in now and start I am just your average. The variations of tethering lesions were tight terminal filum (present in 1 patient), lipoma (5 patients), and lipomyelomeningocele (8 patients). WebOnce the myelomeningocele is freed from all scarred attachments, the dura and the wound are closed. A tethered cord release reduces or removes the . The mean operation time was 220.2 109.0 minutes for untethering surgery and 399.5 9.6 minutes for SSO; as these numbers clearly indicate, the time was significantly longer for the SSO group ( p = 0.01). To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). Log in now and start reading! These electrodes connect to a computer that lets doctors know how well the nerves in your childs head, arms and legs are working throughout the surgery. Unauthorized use of these marks is strictly prohibited. 1994 Oct;81(4):513-9. doi: 10.3171/jns.1994.81.4.0513. Up to 6% of the normal population will be found to have fat within their filum terminale, 14 and many of these individuals will have symptoms of a tethered spinal cord ().The term filum terminale syndrome was coined in 1953 by Garceau, 15 who reported three patients with progressive spinal deformity and neurological dysfunction. If no imaging has been done, your child may need a magnetic resonance imaging (MRI) test of their spine before the appointment. But previous investigation estimated that no more than 40% of dermoid cyst could be completely removed. Long-term results showed a good prognosis in patients in whom first-time (that is, nonrevision) surgery achieved successful untethering, with a 10-year rate of neurological stabilization in 89% of Group A and a 10-year rate of neurological stabilization in 81% of Group B patients. Surgery may also restore some function or The neurological surgeon makes an incision in the lower back to expose the site where the spinal cord is pinned, then frees it by . Some people might continue to have Terminal syringohydromyelia and occult spinal dysraphism. Due to the fact that some patients had to be re-operated in the follow-up due to a retethering episode, we evaluated 38 surgical cases in total. FOIA All the 82 cases of patients received nerve electrophysiology monitoring assisted microsurgery. The mean blood loss was 575.51316.5 mL in untethering surgery cases, but significantly greater in the SSO group: 1,971.81,739.2 mL (p<0.001). Because neurological deficits are generally irreversible, early surgery is recommended. Kenyu Ito, none To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). The https:// ensures that you are connecting to the Iskandar B J, Fulmer B B, Hadley M N, Oakes W J. Congenital tethered spinal cord syndrome in adults. The term occult spinal dysraphism (OSD) encompasses a group of abnormalities that occur during the development of a human embryo, beginning in the third week of gestation. He experienced improvement in leg pain and motor strength after untethering. The nurse will help schedule the COVID-19 PCR test. Surg Neurol. The surgical procedure performed at L1 is described below. Features of the condition may include foot and spinal abnormalities; weakness in the legs; loss of sensation (feeling) in the lower limbs; lower back pain; scoliosis; and urinary incontinence. Federal government websites often end in .gov or .mil. Patients needing surgery for adult TCS are relatively young, so this postoperative complication would be a serious disadvantage of SSO for them. Clinical improvement 1 year after surgery in our study showed back pain improvement in 60% of children and 75% of adults, parathesia improved in 60% of 2022 Oct 6;10(28):10375-10383. doi: 10.12998/wjcc.v10.i28.10375. Object: Phi J H, Lee D Y, Jahng T A, Chung C K, Kim H J. Tethered cord syndrome in adulthood: reconsidering the prognosis. Next, the T12 and L2 vertebrae were compressed gradually by using a pedicle screwrod construct with somatosensory-evoked potentials and motor-evoked potentials monitoring. In Group A, 20 of 43 patients underwent surgery, whereas in Group B 23 of 42 patients underwent surgery. There were 4 cases of patients with grade 0 by preoperative Hoffman grading, 20 cases with grade 1, 28 cases with grade 3, 18 cases with grade 4, 10 cases with grade 5, and remaining 2 cases with grade 6. Surgical treatment is the only effective method to relieve occupying, loose adhesions, and compression, its main purpose is to lift the tethered to reduce the stretching of the taper tension, and thus to control further development of symptoms and to reduce further damage to the nerve function. Activity modification. The child usually can resume normal activities within a few weeks. The General Hospital Corporation. Tethered cord release surgery is a type of surgery to reduce or remove the tissue that is preventing the spinal cord from moving freely. Symptoms often stabilize or improve after surgery; 6 however, retethering (along with renewed symptoms) may reoccur especially during rapid doi: 10.3171/FOC-07/08/E2. Nakashima H, Imagama S, Matsui H, Yukawa Y, Sato K, Kanemura T, Kamiya M, Ito K, Matsuyama Y, Ishiguro N, Kato F. Global Spine J. One patient showed worsening of sensory function and another patient complained of a new lower back pain in the SSO group. Surgery to remove lipomas and free a tethered spinal cord. Disclosures Hiroaki Nakashima, none Syringomyelia is a disorder in which a fluid-filled cyst (called a syrinx) forms within the spinal cord. 9 Patients with such complex pathologies have been found to have a 9 to 50% chance of worsening pain and sensorimotor deficits after untethering.7 Unlike pediatric patients, adults experience degenerative changes that further complicate treatment.5 We offer diagnostic and treatment options for common and complex medical conditions. Intraoperative feasibility of bulbocavernosus reflex monitoring during untethering surgery in infants and children. Patients and methods Adult and children patients with tethered cord syndrome subjected to microscopic surgeries for release of cord and nerves . HHS Vulnerability Disclosure, Help 5 3. The end of the spinal cord normally hangs and moves freely inside the spinal column. This keeps the spinal cord from moving freely. Tethered Cord. Abnormal tissue, growth, tightening, or thickening of tissue can make it hard to move the spinal cord. [2], In 1886, Von Reeklinghausen reported autopsy results of the patients with lumbosacral hypertrichosis accompanied with spina bifida, showing that the spinal cord was adhered to fat in the lumbosacral region, conus terminalis was indicated to be tensed. At your childs first pediatric neurosurgical appointment, you can expect discussions with the care team about whether surgery is appropriate for your child and whether they need different imaging tests done. Let us help you navigate your in-person or virtual visit to Mass General. neurologic recovery with regard to pain and The preoperative duration of symptoms was significantly longer (2512.4 years) and the percentage of those with prior surgery was higher in the SSO group (66.7%). As an alternative to untethering surgery, Kokubun et al have performed SSO since 1995 in patients with TCS caused by a lipomyelomeningocele because osteotomy is believed to reduce the tension in the spinal cord.10 You will have many questions about the disorder, and we are here to answer them. August 2017. Surgical treatment on adult patients with TCS can improve the neurologic deficits which are associated with the course of disease, early treatment has much better curative effect. These back pains were treated conservatively with oral analgesic agents. To be included, patients (1) had to be>18 years old at the time of surgery and (2) had to have undergone spinal surgery for TCS. In addition and preoperatively, there were 68 cases (83%) of varying degrees of pain in the lumbosacral portion and lower extremity, 58 cases (71%) of motor dysfunction of the lower extremity, 44 cases (54%) with abnormal sensation, and 50 cases (61%) of defecation dysfunction. The care team will place a urinary catheter to help urine flow out of your childs body during and after surgery. Improvement in clinical features was compared in the untethering and SSO groups (Table 3). A tethered cord release reduces or removes the . To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). The mean age at onset of symptoms and diagnosis was 30 years and 37 years, respectively. Recovery Over time, the syrinx can get bigger and can damage the spinal cord and compress and injure the nerve fibers that carry information to the brain and from the brain to the rest of the body. PMC After a mean clinical follow-up period of 4 years, significant improvement occurred in 22 of 27 patients presenting with pain, 13 of 27 patients with motor or sensory dysfunction, and 11 of 18 patients with bowel and bladder disturbance. The position in which it comes to rest in an adult (L1 or L2) is caused by the growth of the individual. This site needs JavaScript to work properly. An adult tethered cord syndrome has also been described. All patients received general anesthesia and took their prone position, neural electrophysiological monitoring electrode were then placed, followed by the acquisition and collection of muscle electromyography signals from the anal sphincter, bilateral musculus vastus lateralis, gastrocnemius and mesothenar. For more information, please refer to our Privacy Policy. In children, the surgery to de-tether the spinal cord is more common and can be done at many institutions; the procedure is also lower risk in children than in adults. 20. Conclusions: Scientifica (Cairo). An official website of the United States government. The average length of spine shortening was 23.3 mm. The spinal cord tension was relieved after surgery as shown by preoperative MRI. Tethered cord syndrome (TCS) is a neurologic disorder caused by abnormal traction of the spinal cord resulting from several pathologic conditions: thickened filum terminale, meningocele, lipomyelomeningocele, and split cord malformation.1 In contrast, fusion surgery in SSO might lead to adjacent segment disease that may require subsequent surgery in the long term after SSO. Their clinical charts, operative records, and follow-up data were reviewed. Accessibility A post-traumatic tethered cord can occur . sharing sensitive information, make sure youre on a federal 2020 Oct 29;11:362. doi: 10.25259/SNI_641_2020. Recovery of lost muscle and bladder function depends upon the degree and length of preoperative implications. government site. If the nerves are stretched, they may not work properly, and this can cause problems for your child. Abbreviation: TCS = tethered cord syndrome. 6 As a result, the spinal cord can't move freely within the spinal canal. 8600 Rockville Pike Bone chips from the excised laminae and spinous processes were also placed over the T12 and L1 laminae for posterior fusion. Some error has occurred while processing your request. Red flags that might lead a doctor to suspect tethered cord include any of its symptoms (although the same symptoms can be caused by a number of other spinal cord conditions); a previous diagnosis of a congenital spinal malformation; a history of cancer, infection, spine surgery; or spinal cord injury. [10] Of course, if the relief of tethered parts of the cauda equina obtained a relatively satisfactory outcome during the surgery, most occupying lesions and diseased filum terminale were removed, postoperative symptoms improved at different degrees, further recovery of the nerve function could thus be observed in the long-term follow-up period. Bookshelf A. There were no significant differences in age, sex, and length of follow-up between the two groups. Garg K, Tandon V, Kumar R, et al. The duration of symptoms was significantly longer in the SSO group (2512.4 years) than in the untethering surgery group (8.26.3 years; p=0.01). Shooting pain in the legs. Neurosurg Focus. 1. Tyagi R, Kloepping C, Shah S. Spinal cord stimulation for recurrent tethered cord syndrome in a pediatric patient: case report. However, his condition subsequently deteriorated, and he could not walk by himself 1year after untethering surgery. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. In adults, symptoms of tethered cord usually develop slowly. Tethering or scarring of the spinal cord has been suggested as a pathophysiological cause for the formation of a syrinx or cyst in the spinal cord. 10. OBJECTIVE Tethered cord syndrome (TCS) has been well described in pediatric patients. Successful detethering procedures require careful intradural This is not associated with spina bifida, but may occur in patients with Chiari malformation. Methods: CSF leakage and urinary infection each occurred in 1 patient in untethering surgery cases, and massive intraoperative bleeding (more than 3,000 mL) was observed in 1 patient in the SSO group. In this study, we evaluated the feasibility of BCR monitoring during untethering surgery in infants and children to predict postoperative urinary and bowel dysfunction. Recovery involves a period of immobility where the . Following a tethered cord release surgery, children are typically discharged in 1-2 days after surgery. microsurgery; tethered cord syndrome; tumor. Of 40 cases without occupying lesions of TCS, the symptoms were improved in 14 cases and stabilized in 26 cases, there was no deteriorated case. Values of p<0.05 were considered to indicate statistical significance. Prompt untethering after diagnosis leads to improved . In one of the rst recorded . Careers, Unable to load your collection due to an error. All patients were followed up, no death occurred. HOB, positioning, activity, bathing: The patient is kept flat on bed rest for 3 days to allow for dural healing and to put as little CSF pressure on the dura as possible during this time. stretching. 8 This handout is intended to provide health information so that you can be better informed. Surgery for a Tethered Spinal Cord. Duraplasty using substitute materials was performed at the close of surgery. WebThe dysfunction of nervous system in Cases 1, 2, and 4 disappeared within 3 weeks. PMC The horizontal sacrum as an indicator of the tethered spinal cord in spina bifida aperta and occulta. The care team will discuss the type of tethered cord your child has when they review the imaging of their spine with you. This is common problem for people after any surgery, takes time. The diagnosis of TCS is made with a high degree of clinical suspicion. Surgeries were performed under continuous electrophysiologic neuromonitoring with somatosensory-evoked potentials, combined with motor-evoked potentials, and electromyography with direct nerve root stimulation. Published by Wolters Kluwer Health, Inc. Would you like email updates of new search results? 11 Miyakoshi et al reported that all of the neurologic symptoms in the subjects of one of their studies were relieved without complications after SSO,10 and it was hoped on the basis of that study that SSO would become a preferable approach for TCS in adults, but the number of patients in their study was small (n=3). The authors reviewed their experience of newly diagnosed adult TCS patients to identify and explore TCS misdiagnosis, recognition, subtype pathology . Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. 12. 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan, 2Department of Orthopedic Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan, 3Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan, 4Department of Orthopedic Surgery, Konan Kosei Hospital, Aichi, Japan, 5Department of Orthopedic Surgery, Aichi Medical University, Aichi, Japan, 6Department of Orthopedic Surgery, Hamamatsu Medical University, Shizuoka, Japan. A retrospective analysis of 82 adult patients (17 male cases, 82% and 24 female cases, 59%) with TCS treated by surgery was conducted between March, 2005 and December, 2015, with an average age of 31.6 years and average disease course of 6.7 years. Your childs urinary catheter will be removed. The effect of tethered cord release on coronal spinal balance in tight filum terminale. Postoperative Orders . Rajpal S, Tubbs RS, George T, Oakes WJ, Fuchs HE, Hadley MN, Iskandar BJ. [4] In 1953, Garceau described the filum terminal syndrome, suspected that the tensive filum terminal pulled the spinal cord might cause defecation dysfunction and other symptoms. The .gov means its official. Untethering surgery was performed in 11 patients, and SSO was performed in three patients as initial surgeries for adult TCS in our institutions. In some instances, what is thought to be adult tethered cord syndrome is actually a similar abnormality affecting the spine. The photograph shows thick filum terminale isolated at the time of surgery before sectioning. Careers. Cerebrospinal fluid leakage and urinary infection occurred in 1 patient each among those with untethering, and massive intraoperative bleeding occurred in 1 patient with SSO. A syringo-subarachnoid shunt to drain the cyst. I had tethered cord release and had micro leaks for 7 months with 3 blood patches at different levels. Arai H, Sato K, Okuda O, et al. WebAdult Tethered Cord Release - cns.org Open Access The Nexus online library is your free comprehensive resource for neurosurgical cases and approaches. We would like to thank our colleagues from the Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, and the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University. A retrospective analysis of 82 adult patients (17 male cases, 82% and 24 female cases, 59%) with TCS treated by surgery was conducted between March, 2005 and December, 2015, with an average age of 31.6 years and average disease course of 6.7 years. . 11 Miyakoshi et al reported complete clinical recovery without complications in 2009, which led to the hope that SSO would be the way to reduce perioperative complications and provide better neurologic outcomes.10 Although Kokubun et al also reported good clinical results after SSO in 2011,11 there have been no reports until now of a comparative study or review of these two procedures. 11 Muscle weakness was present in 10 patients (71%), 8 (57%) had leg pain and sciatica, and 6 (43%) had back pain. 9 This may take a few attempts, so it is important to not become discouraged after their first try. 8 Perioperative complications are another concern in adult TCS. Tethered cord syndrome is a stretch-induced functional disorder associated with the fixation (tethering) effect of inelastic tissue on the caudal spinal cord, limiting its movement. Back pain: 14% better; 14% worse; leg pain: 11% better; 11% worse, Back pain: 78% better; 3% worse; leg pain: 83% better; 7% worse, Back pain: 77% better; leg pain: 47% better, 2% extradural hematoma/paraparesis; 5% revision CSF; 2% permanent neurologic worsening, 3% neurologic deterioration; 3% reoperation. Some patients may be misdiagnosed as having sciatica, a more common source of lower back . Meanwhile, patients with shorter disease courses were suggested to accompany with obvious improvement of symptoms postoperatively when compared to those patients preoperatively; besides, the course of disease was within 1 year regarding those patients showing a completely recovery of the abovementioned symptoms.