The Historical Path to the Current Understanding and Management of Tethered Spinal Cord

Keywords: History, spinal cord, tethered cord, urinary function, dysraphism

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     Today "tethered cord syndrome" (TCS) includes, both a separate diagnosis, as well as a combination of symptoms in the context of dysraphic conditions. The common denominator is the increased tension and abnormal stretching of the spinal cord.
     The modern management strategies developed to treat TCS were only developed within the last few centuries.
     The authors perform a comprehensive review of the historical path of the developments that lead to the current treatment of TCS.
     The anatomical description of spinal dysraphism dates back to Nicholas Tulpius in 1641. Athol Johnson gives one of the first clinical descriptions of TCS in an 1857 report of a child. A fatty mass was found, and the spinal cord was freed from its dural attachments. In 1875, Virchow introduced the term spina bifida occulta. In 1891, WL Jones illustrates treatment of a patient; he describes division of a dense adventitious fibrous band. Between 1896 and 1912, Harvey Cushing conducted repair of spinal dysraphism. In 1916,WG Spiller reported that symptoms could be worsened by activity. Recognition that early treatment results in improved outcome was noted in 1918 by WM Brickner. In 1976 Hoffman and colleagues adopted the term tethered spinal cord in a report of patients who presented with motor and sensory deficits in the lower limbs and incontinence, subsiding after sectioning the thickened terminal filum. Several subsequent articles contribute to the understanding of TCS.
     This is a retrospective study.
     The modern understanding of the pathophysiology and microsurgical management of TCS dates back to pioneering contributions around the turn of 19th century.


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