Defining Occult Tethered Cord Syndrome with Clinical Criteria
New Publication: Clinical criteria for filum terminale resection in occult tethered cord syndrome
“The novel symptom and findings scale helps spine surgeons to identify patients with occult tethered cord syndrome who are most likely to benefit from surgery.”
Klinge PM, Leary OP, Allen PA, Svokos K, Sullivan P, Brinker T, Gokaslan ZL. Clinical criteria for filum terminale resection in occult tethered cord syndrome. J Neurosurg Spine. 2024 Mar 15:1-9. doi: 10.3171/2024.1.SPINE231191. Epub ahead of print. PMID: 38489815.
I’m excited to share this new study that just came out - Clinical criteria for filum terminale resection in occult tethered cord syndrome by Dr. Petra Klinge and colleagues published in the Journal of Neurosurgery: Spine. You can find the full text of the paper here, and a summary below!
The goal of this study was to improve the diagnosis and assess outcomes following surgery for occult tethered cord syndrome (OTCS), a condition where the spinal cord is abnormally attached and can lead to various neurological symptoms and pain. For those who aren’t familiar with tethered cord syndrome, I recommend checking out my previous post as a primer for all things occult tethered cord and the relationship to the Ehlers-Danlos Syndromes, before continuing.
OTCS is complicated to evaluate and diagnosis given the lack of clear clinical diagnostic criteria, mostly relying on description of symptoms and clinician experience as there are no straightfoward diagnostic tests or imaging. The authors state that OTCS can be congenital or acquired through ultrastructural collagen damage of the filum temrinale, and their previous studies have shown pathological changes in the filum terminale in even in radiographically normal imaging.
For the study, the research team recruited 149 patients with OTCS who underwent surgery for OTCS (filum terminale resection). They utilized a detailed questionnaire to collect self-reported symptoms and clinical findings from the patients at preoperative, 3-month, and 12-month follow-up examinations. The questionnaire covered a wide range of symptoms associated with OTCS, including leg and back pain, leg fatigue, spasticity, and bowel and bladder dysfunction. Additionally, clinical examinations were conducted to assess neurological signs such as foot clonus, hyperreflexia, and increased muscle tone, which are indicative of upper motoneuron dysfunction. These methods allowed the researchers to construct a 15-item scale representing the three symptom categories of OTCS, enabling them to track the progress of patients post-surgery and predict surgical outcomes accurately.
The results revealed that OTCS presented with specific symptoms indicative of upper motoneuron pathology, including leg and back pain, leg fatigue, and spasticity. Interestingly, despite negative findings on spine MRI, patients exhibited these symptoms, emphasizing the need for alternative diagnostic approaches. The 15-item scale demonstrated significant clinical improvement, with 89% of patients showing improvement at 3 months post-surgery and 68% at 12 months. Moreover, the scale accurately predicted surgical outcomes in 82% of cases, suggesting its utility in identifying patients who would benefit from surgery.
The study's findings highlight the importance of patient-reported symptoms in assessing surgical outcomes for OTCS. Additionally, they shed light on the underlying mechanisms of the syndrome, emphasizing the role of axonal stretch injury to the spinal cord. The results suggest that surgery can effectively manage OTCS, with outcomes comparable to those of degenerative spine surgery. However, further refinement and validation of the scale are needed for its widespread clinical application, along with continued research to better understand and manage OTCS.
Additionally, this study may aid neurosurgeons who do not currently treat OTCS - providing a better guide in diagnosing and treating patients. People who have experience with OTCS or have had surgery, know that finding a neurosurgeon to treat something not seen on imaging can be nearly impossible. More research in this space is crucial to increasing awareness in the medical field and improving access to knowledgeable and effective care!
Paper Citation:
Klinge PM, Leary OP, Allen PA, Svokos K, Sullivan P, Brinker T, Gokaslan ZL. Clinical criteria for filum terminale resection in occult tethered cord syndrome. J Neurosurg Spine. 2024 Mar 15:1-9. doi: 10.3171/2024.1.SPINE231191. Epub ahead of print. PMID: 38489815. https://doi.org/10.3171/2024.1.SPINE231191
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