Adult Tethered Cord Syndrome: New Classification Correlated With Symptomatology, Imaging and Pathophysiology

The concept of tethered cord syndrome (TCS) has been accepted among neurosurgeons during the past two decades, and many children have benefited from surgical procedures. However, adult TCS is often undiagnosed because the pathophysiology, imaging, and clinical manifestations of this syndrome are not well understood. Diagnostic difficulties for adult TCS are mainly derived from the fact that despite the patients' reports of severe low back and leg pain, motor/sensory changes, disturbance in urinary and bowel control, and musculoskeletal deformities are subtle. Too often, these patients are diagnosed as having failed back syndrome or other unrelated spinal problems. Various surgical procedures frequently fail and the patients are placed into the category of failed back surgery syndrome, or untreatable psychosomatic disorder. Proper diagnosis of TCS and timely treatment can lead to restoration of neurologic function and patient gratification. This article is devoted to familiarizing the surgeon with TCS pathophysiology, symptoms, differential diagnosis, and surgical treatment.