Evaluating Sensory Restoration Following Surgical Intervention for Tethered Cord Syndrome: A Scoping Review and Illustrative Cases.

Abstract

Tethered cord syndrome (TCS) is characterized by the caudal anchoring of the spinal cord, causing restricted movement and tension, leading to neurologic, urologic, musculoskeletal, and gastrointestinal symptoms. Neuropathic sensory loss in the lower extremities is prevalent, increasing infection risk and, in severe cases, resulting in amputation. The potential for sensory recovery following surgical intervention in TCS has not been thoroughly documented. This study reviews existing literature and presents 2 illustrative cases of sensory recovery following surgical intervention in TCS patients with severe neuropathic sensory loss leading to amputation. A scoping literature review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to evaluate sensory changes presurgery and postsurgery in TCS patients. Two reviewers independently screened, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. Additionally, chart reviews were conducted for 2 patients who underwent limb amputation and experienced sensory return following tethered cord intervention. The review revealed 1 case series and 4 retrospective cohort studies on sensation following TCS release, all reporting significant postoperative improvements in pain, strength, and notably, sensation. None specifically addressed TCS-related amputations. Two cases are presented where amputee patients with severe neuropathic sensory loss from TCS experienced sensory recovery after surgical interventions. Sensory loss in TCS can lead to sequelae as severe as amputations from repeated wound infections. Surgical intervention may play a role in preventing and treating sensory loss in TCS patients. Further investigation into the mechanisms of sensory loss in TCS is needed.