Mehmet Can EZGÜ, Sait KAYHAN
Journal of Turkish Spinal Surgery - 2026;37(1):17-22
Objective: Tethered cord syndrome (TCS) is traditionally considered a pediatric disorder, yet an increasing number of adults are now diagnosed with symptomatic tethering. Adult presentations often differ from childhood cases, and the extent to which microsurgical detethering benefits this population remains a subject of clinical interest. This study aims to evaluate the clinical and radiological outcomes of microsurgical detethering in adults with TCS. Materials and Methods: This retrospective study included patients aged >=18 years who underwent detethering between 2015 and 2024. Preoperative variables included symptoms, neurological findings, cutaneous stigmata, magnetic resonance imaging (MRI) features, urodynamic results, and tibial nerve somatosensory evoked potentials latency. All patients underwent microsurgical filum sectioning or release of pathological adhesions with routine intraoperative neuromonitoring. Outcomes were assessed through postoperative clinical follow-up and MRI studies. Results: Twenty-one patients (mean age 26.2 years) were included. Back pain (81%), urinary dysfunction (67%), and radicular pain (57%) were the most common symptoms. A low-lying conus was present in 95% of subjects, and a thick filum in 76%. Split cord malformation occurred in 38% of patients and syringomyelia in 24% of patients. At a mean follow-up of 21.3 months, leg pain resolved in all affected patients, urinary incontinence improved in 78% of patients, and syringomyelia decreased in 60% of patients. Only one cerebrospinal fluid leak occurred, and no retethering was observed. Conclusion: Microsurgical detethering resulted in meaningful symptom relief and radiological improvement in most adult TCS patients, with low complication rates. These findings support surgical intervention as an effective treatment option for symptomatic adults.
