Surgical Management and Outcome of Tethered Cord Syndrome

Study Overview
=================
Brief Summary
-----------------
The aim of this study is to assess surgical management and outcome of Tethered cord syndrome

Detailed Description
-----------------
Tethered cord syndrome (TCS) is a developmental abnormality of the neuroaxis which is usually diagnosed in childhood. The actual tethering has been attributed to a variety of pathologic entities, including a thickened tight filum terminale , intradural lipomas with or without a connecting extradural component, intradural fibrous adhesions, diastematomyelia, and adherence of the neural placode following previous closure of a myelomeningocele. However, sufficient differences in the mode of onset, clinical manifestations, and outcome exist between pediatric and adolescent patients with tethered cord to warrant a more detailed analysis of the adult syndrome. The most problematic technical consideration in surgery for the release of the tethered cord is how to preserve functioning neural elements and rebuild the dural sac to avoid CSF leak. The purpose of this study is to review causes of Tethered cord, clinical presentation, diagnostic tools, treatment options and outcome in school-aged children, adolescents, and young adults with Tethered cord.

Official Title
-----------------
Tethered Cord Syndrome: Surgical Management and Outcome

Conditions
-----------------
Tethered Cord Syndrome

Intervention / Treatment
-----------------
* Procedure: Detethering of the spinal cord


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients with Tethered cord syndrome presenting at our institute Patients with spinal dysraphism Lipomyelomeningocele with Tethered cord patients presented with neurological deficit after lipomyelomeningocele repair due to Tethered cord patients presented with neurological deficit after myelomeningocele repair due to Tethered cord Diastematomyelia with Tethered cord - Tethered cord due to filum terminale. Tethered cord due to fibrous adhesions Exclusion Criteria: Asymptomatic Patients with Tethered cord discovered accidentally

Ages Eligible for Study
-----------------
Minimum Age: 1 Year
Maximum Age: 16 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Detethering of the spinal cord|Release of the tethered spinal cord|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Motor power | Outcome of Detethering of the Tethered spinal cord according to Motor power of the lower limbs 5 grades 0: No visible muscle contraction Visible muscle contraction with no or trace movement Limb movement, but not against gravity Movement against gravity but not resistance Movement against at least some resistance supplied by the examiner Full strength | Two years | 
| Sensations | Outcome of Detethering of the Tethered spinal cord according to the sensations of lower limbs , is there decreased sensations of lower limbs and if improved or not | Two years | 
| Sphincter's function | Outcome of Detethering of the Tethered spinal cord according to is there urinary incontinence or stool incontinence and if improved or not | Two years |