tethered cord surgery in adults recovery time

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tethered cord surgery in adults recovery time

To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). 3. The site is secure. For this procedure, the patient is placed under general anesthesia. Lew SM, Kothbauer KF. Epub 2012 Jul 13. Tethered cord syndrome is a rare neurological condition. But previous investigation estimated that no more than 40% of dermoid cyst could be completely removed. All of the included 82 cases of patients received preoperative enhanced magnetic resonance imaging (MRI) examination, and there were several characteristics listed as follows: thickened filum terminale in a diameter of >2 mm; elongated, tapering, and low position of the coni medullaris, the coni medullaris located below the plane of vertebral body (L2) was considered to be low position of the coni medullaris; coni medullaris or the filum terminale attached closely to the posterior wall of the thecal sac, in a relatively straight shape; a large subarachnoid space was existed in the sacral canal; possible existence of occupying lesions adhered to the coni medullaris or the cauda equina, such as lipoma, dermoid cyst, and epidermoid cyst; potential existence of myelomeningocele or changes after prosthesis (Fig. WebThe clinical recurrence rate in all conservatively treated patients was 21% after 10 years. Adults. Throughout the entire surgery, the care team will check how your childs spinal cord is working properly. Klekamp[14] advocated that for small lipoma and cone did not show obvious compression, the symptom is mainly caused by tethered, simply releasing of the tethered is suitable to prevent postoperative adhesion and not to destroy lipoma; and for larger lipoma compressed the conus medullaris, decreasing the volume of lipoma from internal, retaining the capsule, and sewing up the incision will be more effective to reduce the possibility of adhesion. In contrast, fusion surgery in SSO might lead to adjacent segment disease that may require subsequent surgery in the long term after SSO. And if you do have to take laxatives - just go ahead and do that. However, his condition subsequently deteriorated, and he could not walk by himself 1year after untethering surgery. [3,4] Adult onset cases are rare compared to that in children. Garceau GJ. 9 Moreover, successful untethering correlates with the complexity of the malformation and is extremely difficult to accomplish without causing intraoperative complications.9 Consequently, untethering surgery for adult patients with complex tethering pathologies remains challenging.9. smoke city char bar los angeles; youth sports referee jobs; que pasa cuando los dos amantes son casados; margot robbie samara weaving and jaime pressly Of these patients, there were 34 males and 48 females, with an age range of 18 to 47 years (average age, 31.6 years), and average disease course of 6.7 years. doi: 10.1097/MD.0000000000010111. To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). Suite F4300. 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. Improvement in clinical features was compared in the untethering and SSO groups (Table 3). 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. Preoperative motor deficits improved in 67% of the patients. 4 Cauda equina was managed by sharp releasing adhesion under the nerve electrophysiological monitoring, tumors were removed with the use of medical ultrasonic dissector. 8. 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. First, it was a retrospective review of a small number of patients, due to the fact that the number of adult patients with TCS is relatively low, so securing a large number of patients for the study (especially patients with SSO) was difficult even though the study was a multicenter one. As first-line treatment, patients presenting with TCS typically undergo direct spinal cord untethering, often as young children or infants. 5 In surgically treated patients, pain relief can often be achieved, and long-term neurological stabilization tends to persist more often than it does in conservatively treated patients. Postraumatic syringomyelia involves development of a fluid-filled cavity (called a cyst or syrinx) within the spinal cord following a spinal cord injury. Treatment helps patients with tethered spinal cord syndrome have a normal life expectancy. stretching. Neurosurg Focus. government site. The authors studied the hospital records of 34 consecutive patients who presented in adulthood with tethered cord syndrome and conducted follow-up phone interviews with 28 of them. We report a 63-year-old man with sudden-onset severe right chest and upper back pain, followed by . official website and that any information you provide is encrypted In the adult population, many patients receive inadequate care unless they are seen at a multidisciplinary clinic. 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. Surgical options include: Suboccipital decompression for Chiari malformation. Safe Care CommitmentGet the latest news on COVID-19, the vaccine and care at Mass General.Learn more. Disclaimer. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2016 Sep;6(6):535-41. doi: 10.1055/s-0035-1569004. 10 The care team will discuss the type of tethered cord your child has when they review the imaging of their spine with you. Methods: 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. This way, the care team can best assess your childs condition at their first appointment. Tethered cord release surgery is a type of surgery to reduce or remove the tissue that is preventing the spinal cord from moving freely. The attached tissue limits the movement of the spinal cord within the spinal column and causes an abnormal stretching of the spinal cord and impairment of blood flow to the nerve tissue. Careers, Unable to load your collection due to an error. The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies. At surgery, the spinal cord was freed from its attachments to the dura, and the symptoms resolved [13]. Surgical effects were evaluated by observing improvement of symptoms of each patient postoperatively. Pathophysiology of tethered cord syndrome and similar complex disorders. Please enable scripts and reload this page. Quiones-Hinojosa A, Gadkary CA, Gulati M, von Koch CS, Lyon R, Weinstein PR, Yingling CD. Surgical effects were evaluated according to Hoffman grading system. This causes extra stress on the nerves and can cause a range of symptoms known as tethered cord syndrome. This can cause many different symptoms called tethered cord syndrome. Mitsuhiro Kamiya, none Unable to load your collection due to an error, Unable to load your delegates due to an error. In children surgery prevents further neurological deterioration. Cutaneous stigmata (hypertrichosis, dermal pit, or hairy patch) were the most common features in 12 patients (86%). 1. A lumbar laminectomy for release of a tethered cord. Careers. 96(32):e7808, Comparative Study of Untethering and Spine-Shortening Surgery for Tethered Cord Syndrome in Adults. Over time, the term ''tethered cord'' has been . In adults, symptoms of tethered cord usually develop slowly. Neurosurgery. 7. Analysis was performed according to Hoffman grading system. Dermoid cyst and epidermoid cyst caused TCS was observed in 32 cases, with 6 cases indicating improved symptoms, 26 cases showing stabilized symptoms, and no case got worse. After the tumor was removed, the dura mater spinalis with low tonus was closed by water, and the dura mater spinalis with high tonus was formed by the autogenous fascia. Foley catheter removed on postoperative day one. 5 Surgery in adult patients with a tethered cord syndrome should be reserved for those with symptoms. Based on this small retrospective case series, SSO appears to provide clinical improvement at least comparable to that of the untethering procedure, especially in more challenging cases (complex malformations or revision surgery). Tethered cord results when the spinal cord cannot normally ascend with growth, which . 12. 12 WebIn adults, symptoms of tethered cord often develop slowly, but they can become quite severe. For more information about these cookies and the data After identification of the terminal filum, we confirmed electromyography activity on bipolar stimulation before clip ligation and definitive sectioning. Improvement in back pain and leg pain or numbness usually happens first, and bladder and bowel improvement happen last. The care team will place a urinary catheter to help urine flow out of your childs body during and after surgery. 11 SSO was performed at the level of T12 or L1 (Fig. [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. An official website of the United States government. Postoperative Orders . Tethered cord occurs when the spinal cord is attached to tissues around the spine, most commonly at the base of the spine. 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 . Lower back pain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. In some instances, what is thought to be adult tethered cord syndrome is actually a similar abnormality affecting the spine. 9 (B) Preoperative sagittal T2-weighted magnetic resonance imaging (MRI) scan shows a low-placed conus medullaris and terminal filum connected with a subcutaneous lipomyelomeningocele at the S1S2 level. 7 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. Surgical experience of 120 patients with lumbosacral lipomas. flag football tournaments 2022 tethered spinal cord surgery recovery time. TCS in adults is relatively rare and includes a wide spectrum of pathologies.1 Van Leeuwen et al established four subgroups based on their original tethering pathologies and reported the clinical outcomes after untethering surgery: (1) postrepair myelomeningocele; (2) terminal filum lipoma and tight terminal filum; (3) lipomyelomeningocele and conus lipoma; (4) split cord malformation.5 These etiologic backgrounds were found to affect the clinical outcome after untethering. After untethering surgery, CSF leakage, neurologic deterioration, hematoma, difficult wound healing, and meningitis have been reported (Table 5).1 A tethered cord release reduces or removes the . Review of the literature]. Clinical features at presentation are summarized in Table 1. After surgery, the lipoma was removed almost completely (B). 1994 Oct;81(4):513-9. doi: 10.3171/jns.1994.81.4.0513. 16. The surgical release degrees for TCS with different pathologic changes are shown in Table 1. . Number of patients with organ space infection within 30 days of principal operative procedure Readmission within 30 days Return to the OR within 30 days Educational Module Download Tethered Cord: Post-Operative Care Educational Module Updated February 12, 2021 Key References: Bowman RM, Mohan A, Ito J, Seibly JM, 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. (C) Postoperative lateral radiograph 3 years after surgery shows complete bone union and significant spine shortening. Bristow RG, Laperriere NJ, Tator C, et al. Surgical treatment was indicated for patients with radiologically proven tethering of the spinal cord who consistently showed progressive neurologic deficits, back/lower limb pain, or sphincter dysfunction. In the patients who had undergone myelomeningocele repair during infancy or previous untethering surgery, meticulous dissection was required to ensure complete release of the spinal cord because of extensive arachnoidal adhesions. sharing sensitive information, make sure youre on a federal In adults, if the only abnormality is a thickened, shortened filum, then a limited lumbosacral laminectomy may suffice, with division of the filum once identified. PMC Tethered cord syndrome treatment. 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. 8 Recovery of lost muscle and bladder function depends upon the degree and length of preoperative implications. may email you for journal alerts and information, but is committed Surgical management of tethered spinal cord in adults: report of 54 cases. PMC Revision surgery in patients with complex dysraphic lesions should be performed in exceptional cases only. 7 Tethered Cord Syndrome in Children and Adults. Through the long-term follow-up, patients with a shorter duration, lighter TCS degree, generally the prognosis would be good, and symptoms improved significantly; on the other hand, for patients with longer course of disease, serious TCS, and higher frequency that tumor wrapped around the cauda equina, corresponding surgery effect was not so obvious; some patients even showed no improvement of symptoms, and the risk of postoperative TCS was relatively high. The variations of tethering lesions were tight terminal filum (present in 1 patient), lipoma (5 patients), and lipomyelomeningocele (8 patients). From a surgical perspective, it is only necessary to remove the bony or . The site is secure. smart luggage set with cup holder and usb port, patriot league football coaches' salaries. 2014; 192:221-7. . The position in which it comes to rest in an adult (L1 or L2) is caused by the growth of the individual. 9 Institutional review board approval was obtained for medical records review. 15 Meanwhile, a history of prior surgery and complex preoperative categories of tethering lesions are also risk factors for worse clinical outcomes.7 The https:// ensures that you are connecting to the The horizontal sacrum as an indicator of the tethered spinal cord in spina bifida aperta and occulta. Miyakoshi N, Abe E, Suzuki T, Kido T, Chiba M, Shimada Y. Spine-shortening vertebral osteotomy for tethered cord syndrome: report of three cases. 11 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). Perioperative complications are another concern in adult TCS. Yukihiro Matsuyama, none 714-509-7070. Long-term surgical results and patient outcome ratings were encouraging. Pathway Background and Objectives. Selcuki M, Mete M, Barutcuoglu M, et al. August 2017. An adult tethered cord syndrome has also been described. This keeps the spinal cord from moving freely, leading to stretching and tension that can cause nerve damage. In some instances, what is thought to be adult tethered cord syndrome is actually a similar abnormality affecting the spine. (A) A 37-year-old male patient with a lumbar spinal lipoma at L3/L4 level. [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. In the case of adult tethered cord not . 2. You may be trying to access this site from a secured browser on the server. 2021 Feb 16;88(3):637-647. doi: 10.1093/neuros/nyaa491. All patients were followed up, no death occurred. 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. Results. Their clinical charts, operative records, and follow-up data were reviewed. However, some neurological and motor impairments may not be fully correctable. ERAS is a set of steps to follow to help people recover better and faster after surgery. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The surgical scheduler will work with you and family to coordinate a surgical date that fits best into your and your childs schedules. Fixing Tethered Cords in Children vs. The patients' backgrounds in the two groups are summarized in Table 2. When surgeons operate around the spinal cord, the area where the CSF lies is opened so they can untether the spinal cord. Although untethering surgery has been a standard treatment in patients with adult tethered cord syndrome (TCS), spine-shortening osteotomy (SSO) has recently been performed as an alternative technique. Duraplasty using substitute materials was performed at the close of surgery. Muscle weakness was present in 10 patients (71%), 8 (57%) had leg pain and sciatica, and 6 (43%) had back pain. You or your child can typically resume usual activities within a few weeks after surgery. He or she can have a pillow but do not raise the head of the bed. This lessens the chance of any major complications caused by damage to the spinal cord. 13 Therefore, untethering surgery is not always a promising procedure.11. Chern JJ, Dauser RC, Whitehead WE, Curry DJ, Luerssen TG, Jea A. Spine (Phila Pa 1976). Before your childs first visit, be sure to bring or send any imaging tests of your childs spine. Among them, lipoma-oriented TCS was found in 10 cases of patients, of which including 2 cases showing symptoms improvement, 8 cases showing symptom stabilization, no case got worse. Recovery from the surgery is one to two weeks of . Your message has been successfully sent to your colleague. Patient age ranged from 19 to 75 years. Of 32 cases with tethered spinal cord caused by dermoid cyst and epidermoid cyst, the symptoms were improved in 6 cases. 8 Phi J H, Lee D Y, Jahng T A, Chung C K, Kim H J. Tethered cord syndrome in adulthood: reconsidering the prognosis. This causes stretching of the spinal cord as your child grows, leading to extra stress on nerves. This means a shorter, Walk on their own (if appropriate for age), Diazepam (Valium) to prevent muscle spasms. [] This entity was first described by Garceau (1953) and As the child grows taller, the spinal cord is stretched. The combined complication rate of this surgery is usually 1-2%. Statistical analyses were performed using SPSS version 18 (SPSS Inc., Chicago, Illinois, United States). Only 5 of the conservatively treated patients experienced clinical deterioration over time; in 4 of these individuals with deterioration, surgery had been recommended but was refused by the patient. WebAdult spinal deformity, which can result from disk degeneration, spinal arthritis, and prior surgeries that fail to align the spine, is an increasing problem among aging Americans. Fax: 214-456-2497. The patient with tight terminal filum underwent untethering surgery. It is not possible to predict whether your childs current symptoms will reverse. All the 82 cases of patients received nerve electrophysiology monitoring assisted microsurgery. With a recommendation for surgery this figure rose to 47% within 5 years. 1. 5 Dallas. Methods: [20] Therefore, early diagnosis and early surgical treatment will be possible to obtain a better prognosis for patients with symptomatic adult TCS. Equipment. The site is secure. A hairy patch overlying the spine in any area is almost always associated with an underlying splitting of the spinal cord by a band of fibrous tissue or bone (a diastematomyelia). Overall, it remains unclear which procedure is preferable for TCS in adults: untethering surgery or SSO. Disclosures Hiroaki Nakashima, none Fumihiko Kato, none, National Library of Medicine For larger cysts, it is not possible to force the free capsule wall directly, because the cone and the cauda equina are in a high tension state, and any tiny stretching is likely to cause further damage. Bethesda, MD 20894, Web Policies The patient was a 36-year-old man who had undergone myelomeningocele repair during infancy. I had tethered cord release and had micro leaks for 7 months with 3 blood patches at different levels. As this is just a retrospective study that does not involve any interventions, ethical approval was not necessary according to the rules of the hospital. 1). We are committed to providing expert caresafely and effectively. It is recommended that routine examination of filum terminale should be performed in the operation, associated with the disconnection of the diseased filum terminale subject to adhesion or thickening and shortening. eCollection 2020 Mar. 2019 Feb;33(1):155-163. doi: 10.1007/s10877-018-0127-2. Abstract. There were no significant differences in age, sex, and length of follow-up between the two groups. 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. 7 government site. The overall clinical improvement was significantly greater in the SSO group (90.0%) than in the untethering group (33.3%; p=0.003). This may take a few attempts, so it is important to not become discouraged after their first try. Naoki Ishiguro, none A tethered spinal cord occurs when the inelastic tissue on the caudal spinal cord is abnormally attached to a structure instead of free floating. [6] In 1981, Yamada et al[7] found in animal studies that the role of mitochondrial metabolism was reduced in the termination of spinal cord, the greater the tension, the longer the time, and the more serious the nervous dysfunction was. The authors prefer to limit bathing to a sponge bath until the patient is seen in clinic 1 week later. Object: Frequent micturition, diminished knee and ankle reflexes, and difficulty in bending were exhibited in partial patients. This handout is intended to provide health information so that you can be better informed. 13. The operation curative effects for TCS with different symptoms. 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. The most common presenting feature was pain, followed by weakness and incontinence. Primary is typically a form of OSD while secondary usually occurs following a myelomeningocele repair or other type of spinal cord surgery History and Exam Tethered spinal cord is most commonly diagnosed in infancy by the discovery of a abnormality noticed on the skin of the back. J Neurosurg. Medicine (Baltimore). Going from horizontal to vertical felt like being hit in the back of the head with a baseball bat. Activity modification. One patient in the untethering surgery group underwent SSO because the symptoms worsened 1year after untethering. 5 As a result, the spinal cord cant move freely Physical therapy. To the best of our knowledge, there have been no reports on comparisons of the surgical results of the two procedures for TCS in adults. The .gov means its official. eCollection 2020. If no imaging has been done, your child may need a magnetic resonance imaging (MRI) test of their spine before the appointment. Recovery was mostly seen in infants and only in one older child. We use cookies and other tools to enhance your experience on our website and Please enable it to take advantage of the complete set of features! All patients were followed up, no death occurred. Besides, there was no deteriorated case. Values of p<0.05 were considered to indicate statistical significance. J Neurosurg. You may search for similar articles that contain these same keywords or you may Kokubun S, Ozawa H, Aizawa T, Ly N M, Tanaka Y. Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. Adult Tethered Cord is characterized by a spinal cord that is located at an abnormally low position within the spinal canal. Tethered cord syndrome (TCS) refers to a series of neurological dysfunction caused by the retraction of the conus medullaris related to a variety of reasons, which is manifested by both lower extremities orbicularis weakness, sensory abnormalities, defecation dysfunction, and so on.[1]. [Intramedullary mature teratoma associated with an attached cord and an intradural lipoma. A T12 to L1 diskectomy and L1 upper one-third vertebral body resection were performed thereafter. [11] In this paper, we suggest that it is possible to cut off the filum terminale if there will have no injury to the nerve under electrophysiological monitoring, corresponding prognostic outcome will be better than that that without disconnection of filum terminale. The categories of tethering lesions were tight terminal filum in 1 patient, lipoma in 5 patients, and lipomyelomeningocele in 8 patients. The .gov means its official. Pathology and treatment of tethered cord syndrome with lipoma. This is common problem for people after any surgery, takes time. Yasutsugu Yukawa, none This can cause the spinal cord to stretch out as the spine grows, leading to possible nerve damage, pain and other symptoms. J Neurosurg Spine. Tethered cord, also called tethered spinal cord syndrome, occurs when the spinal cord abnormally attaches to tissue inside the spinal canal, usually at the base of the spine. This calls for a wider recognition of the fact that tethered cord syndrome can present in adulthood also. It is not a substitute for medical advice and should not be used to treatment of any medical conditions. 5 Sometimes, the spinal cord nerve roots are cut. Chapman P H. Congenital intraspinal lipomas: anatomic considerations and surgical treatment. There is very little out there on tethered cord in adults. In adults, surgery to detether (free) the spinal cord can reduce the size and further development of cysts in the cord and may . Bethesda, MD 20894, Web Policies WebThe surgery typically takes about four hours, but often takes longer as the neurosurgeon works to remove the adhesion. The purpose of this study was thus to fill in this knowledge gap by comparing the surgical results of untethering surgery and SSO for treating TCS in adults. WebSurgery is a treatment option for tethered spinal cord syndrome; however, to relieve pain if surgery is not advisable, the spinal cord nerve roots may be cut. Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients. 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). 10. To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). Would you like email updates of new search results? 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. modify the keyword list to augment your search. WebConclusions: Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. Copyright 2007-2023. 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 In contrast, sensory deficits were less likely to improve; numbness and paresthesias remained unchanged in 55% of the patients. Of 10 cases with lipoma tethered spinal cord, corresponding symptoms were improved in 2 cases. Some surgeons require the patient to remain flat in bed for a couple of days to minimize the risk of spinal fluid (CSF) leakage from the wound. 11 He presented with symptoms of lower back pain and legs pain. In adults, dethetering of the spinal cord . Following postoperative lumbar spine reexamination by MRI, corresponding results were as follows: postoperative position of coni medullaris was relatively improved than that of the preoperative, and the width was broadened to the posterior wall of the thecal sac; the tension of filum terminale was decreased, filum terminale, and cauda equina showed relatively normal morphology, filum terminale apart from the posterior wall of the thecal sac was found in a part of cases of TCS patients; and if there was occupying lesions, volumes of occupying lesions showed decreased trends and indicated alleviated adhesion or compression to the coni medullaris or cauda equina.

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