Tethered Cord Syndrome in Patient with Lipomyelomeningocele: A Case Study

I Gusti Ayu Sri Mahendra Dewi, Ni Putu Sriwidyani, Desak Made Cittarasmi Saraswati Seputra

Abstract


Introduction: Tethered Cord Syndrome (TCS) is a condition that occurs due to spinal cord traction caused by the attachment of the spinal cord to the surrounding tissues. The incidence of TCS is quite rare, approximately 0.25 per 1,000 live births

 

Case Presentation: We reported a 4-year-old female patient with a lump on her sacral region since birth which enlarged over time. The patient experienced intermittent fever for 1 month before hospital admission and constipation since infancy. Physical examination revealed a lump with a diameter of 6 cm on her sacral region with no neurological abnormality. Ultrasonography examination showed an anechoic lesion with multiple linear structures on supragluteal sinistra with a size of 2.2 x 2.5 x 2.1 cm. MSCT findings showed spina bifida at L5 until S2 level with features of lipomyelomeningocele and tethered cord started from L2 level. Bilateral hydronephrosis, hydroureter, and distended bladder (pine tree appearance) with the possibility of the neurogenic bladder were also found on MSCT examination. The patient underwent surgery to excise the lump and to release the tethered cord. Microscopic findings from excised mass showed a group of neuronal and glial cells, the syncytial sheet pattern of meningothelial cells, and foci of calcification which supported lipomyelomeningocele diagnosis.

 

Conclusions: : Intensive follow-up care and observation must be carried out in children with spinal dysraphism because it may be associated with TCS which may be asymptomatic at an early stage.


Keywords


lipomyelomeningocele, neurogenic bladder, occult spinal dysraphism, tethered cord syndrome, urinary tract infection

References


Atta CA, Fiest KM, Frolkis AD, et al. Global birth prevalence of spina bifida by folic acid fortification status: a systematic review and meta-analysis. AJPH. 2016;106(1): e24-e34

Jain RK, Meena R, Shristi S, et al. Tethered cord syndrome - a rare case report. Int J Curr Res Rev. 2018;10(2):33-7.

Khoshhal K, Murshid W, Elgamal E, Salih M. Tethered cord syndrome: A study of 35 patients. J Taibah Univ Med Sci. 2012;7(1):23-8.

Bhimani AD, Selner AN, Patel JB, et al. Pediatric tethered cord release: an epidemiological and postoperative complication analysis. J Spine Surg. 2019;5(3):337-50.

Sarris CE, Tomei KL, Carmel PW, Gandhi CG. Lipomyelomeningocele: pathology, treatment, and outcomes. Neurosurg Focus. 2012;33(4):E3.

Duma F, Bojadzieva S, Sofijanova A, et al. Tethered cord syndrome in children-report of two cases. Mac Med Review. 2017;71(2):136-9

Ba G, Wu Q, Chen Y, et al. Prevalence and time trends of spina bifida in fourteen cities located in the Liaoning province of northeast China, 2006–2015. Oncotarget. 2017; 8(12): 18943-18948

Sahmat A, Gunasekaran R, Mohd-Zin SW, et al. The prevalence and distribution of spina bifida in a single major referral center in Malaysia. Front Pediatr. 2017;5:1-8.

Rahmad SN, Valentino A, Masdar H. Gambaran kasus spina bifida di RSUD Arifin Achmad Provinsi Riau periode 2015-2017. JIK. 2020;14(1): 49-55.

Imbard A, Benoist J, Blom HJ. Neural tube defects, folic acid and methylation. Int J Environ Res Public Health. 2013; 10: 4352-4389

Wiradnyani LAA, Khusun H, Achadi EL, et al. Role of family support and women’s knowledge on pregnancy-related risks in adherence to maternal iron–folic acid supplementation in Indonesia. Public Health Nutrition. 2016;19(15):2818–2828.

Fiedler, Jack, D’Agostino, Alexis, Sununtnasuk, Celeste. Nutrition technical brief: a rapid initial assessment of the distribution and consumption of iron–folic acid tablets through antenatal care in Indonesia. Virginia: Spring; 2014

Geyik M, Alptekin M, Erkutlu I, et al. Tethered cord syndrome in children: a single-center experience with 162 patients. Childs Nerv Syst. 2015;31:1559-63

Hertzler DA, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus. 2010;29(1):E1

Sofuoglu OE, Abdallah A, Emel E, et al. Management of tethered cord syndrome in adults: experience of 23 cases. Turk Neurosurg. 2017;27(2):226-36

Sysoev K, Tadevosyan A, Samochernykh K, Khachatryan K. Prognosis of surgical treatment of the tethered cord syndrome in children. Childs Nerv Syst. 2018;34(2):305-10


Full Text: PDF

DOI: 10.33371/ijoc.v16i2.852

Article Metrics

Abstract view : 46 times
PDF - 21 times

Refbacks

  • There are currently no refbacks.


Copyright (c) 2022 Indonesian Journal of Cancer

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.