Additional contribution of phonophoresis and low-level laser therapy to exercise in the treatment of carpal tunnel syndrome: A clinical, electrophysiological, and ultrasonographic evaluation.

OBJECTIVES: Carpal Tunnel Syndrome (CTS) is the most common peripheral nerve compression syndrome. This study aims to evaluate the additive contribution of phonophoresis and low-level laser therapy (LLLT) to tendon and nerve gliding exercises electrophysiologically, ultrasonographically, and clinically in the treatment of moderate CTS. METHODS: The sample consisted of 45 patients with moderate CTS, randomized into three groups. Group 1 received phonophoresis and exercise, Group 2 received LLLT and exercise, and Group 3 received exercise alone. Participants were evaluated electrophysiologically, clinically, and ultrasonographically before treatment and at the 6th and 12th weeks after the treatment. RESULTS: An improvement was observed in clinical parameters (Boston Functional Status Scale, Boston Symptom Severity Scale, visual analog scale at rest, and visual analog scale during activity) for all groups at the 6th and 12th weeks after the treatment (p<0.05). An improvement was also noted in the ultrasonographic parameter (cross-sectional area) for all groups at the 12th week after the treatment (p=0.017). CONCLUSION: Phonophoresis and LLLT do not provide additional effects to exercise therapy. Exercise therapy alone may positively contribute to ultrasonographic and clinical outcomes in the treatment of moderate CTS.

Prognostic factors in patients with cerebral sinus venous thrombosis presenting with hemorrhage and papilledema.

OBJECTIVE: The thromboinflammatory process is considered to play a role in the pathogenesis and prognosis of cerebral sinus vein thrombosis (CSVT). The purpose of the study was to compare the thromboinflammatory parameters between individuals with CSVT and healty controls. Additionally, the study sought to compare these parameters among CSVT subgroups with and without haemorrhage, as well as with and without papilledema. Furthermore, the investigation also aimed to identify which parameters had a more significant impact on the risk of hemorrhage and the development of papilledema in CSVT. METHODS: Thromboinflammatory parameters were compared retrospectively between the CSVT group of 88 patients and 80 age- and sex-matched healthy controls, and in the CSVT subgroups with (n = 35) /without hemorrhage (n = 53) and with (n = 52) /without papilledema (n = 36) after ethics committee approval. In both groups, parameters contributing to the risk of hemorrhage and papilledema development were determined by univariate and multivariate analyses. RESULTS: Regarding the risk of hemorrhage in CSVT patients, the most significant factors included hematocrit of <30.2 (%), mean platelet volume of ≤8.9 fL, neutrophil count of >5600, and hsCRP of >9 mg/L. Regarding the risk of papilledema development, the most important risk factors were age of ≤49, presence of vomiting, presence of blurred vision, HDL of >47 mg/dL, and D-dimer of >178 ng/mL. CONCLUSION: It was suggested that evaluating serum thromboinflammatory parameters, as well as demographic characteristics and neurological examination findings, had a critical role regarding prognosis and predictive factors in CSVT.

Evaluation of the visual system with visual evoked potential and optical coherence tomography in patients with idiopathic Parkinson's disease and with multiple system atrophy.

BACKGROUND: In addition to motor findings, non-motor findings including alterations in visual acuity, decrease in blink reflex, and pupil reactivity cause the impaired quality of life in idiopathic Parkinson's disease (PD) and multiple system atrophy (MSA). Our study aimed to examine possible latency and amplitude changes in pattern visual evoked potentials (pVEP) along with retinal and macular changes in optical coherence tomography (OCT) in PD and MSA groups. We also intended to investigate whether any OCT parameters could be a biomarker for Parkinson's or MSA. METHODS: Our study included 50 patients with PD, 15 with MSA, and 50 healthy control subjects. All patients in the study underwent neurological and ophthalmological examination and investigations of OCT to measure the retinal and macular thickness and pVEP to assess visual pathways. RESULTS: When PD, MSA, and control groups were compared, a significant difference was found in all retinal thickness values in average, nasal, and superior retinal nerve fiber thickness (pRNFL), and in all macular thickness values except nasal outer and inferior outer quadrants and in ganglion cell complex (GCC) thicknesses (p < 0.05). Moreover, a significant difference was found in N75, P100, and N145 latencies and N75-P100 amplitude (p < 0.05). The thickness of both pRNFL, inner and outer macular quadrants, was thinner in the MSA group than in PD but GCC thickness was thinner in PD group. CONCLUSIONS: The present study compared pVEP and OCT parameters in PD and MSA groups. It was concluded that pVEP and OCT examinations were of importance in that they were easily accessible, affordable, noninvasive biomarkers that might be used in early periods and progression of the disease and in follow-up.

Evaluation of the patients diagnosed as idiopathic intracranial hypertension with and without papilledema visual pathways by analysis of visual evoked potential.

Background Idiopathic intracranial hypertension (IIH) is a clinical syndrome characterized by increased intracranial pressure in the absence of clinical, laboratory, or radiological findings of space-occupying lesion in the cranium. Papilledema is found in majority of the patients with IIH while it is absent in only about 5-6% of the patients. Methods Our primary objective was to evaluate the patients with IIH with (n: 45) and without (n: 15) papilledema using cranial MRI and VEP analyses and to compare the obtained results. Diagnosis of IIH according to ICHD-3 criteria admitted to and followed in our clinic before receiving any treatment between 2008 and 2018 were reviewed retrospectively after obtaining approval from the Ethics Committee. Results There was no statistically significant difference between both groups' ages (P: 0.494) while differences in lumbar puncture (LP) opening pressure and VAS were found to be statistically significant (p = 0.034, 0.001, respectively). In our VEP investigation, it was seen that latencies in the group without papilledema were seen to be closer to those in the control group (P latency: 0.706, P amplitude: 0.080). Increase in latency and decrease in amplitude were seen in the group with papilledema compared to the group without papilledema (p < 0.001). Conclusion In conclusion, alterations in the optic nerve may be detected with VEP investigation before the detection of papilledema through ophthalmoscopic examination in these patients. Thus, VEP investigation may be considered to have predictive value. VEP examination may be recommended in diagnosis and treatment and during follow-up periods.

Highlights Clinical imaging (cranial MRI-MR-angiography-venography) and VEP analyses were evaluated comparatively with detail in the patients with and without papilledema. In the literature, there are studies on VEP analysis. They have been done on acute and chronic stages of idiopathic intracranial hypertension. In the present study, the patients with and without papilledema were compared in contrast to other studies. Increased VEP latency was seen in both groups being especially more prominent in the group with papilledema.

RETRACTED ARTICLE: Evaluation of macular thickness and visual pathways using optic coherence tomography and pattern visual evoked potential in different clinical stages of obstructive sleep apnea syndrome.

AIM: The present study aimed to investigate and compare possible changes in amplitude and latency of pattern visual evoked potentials (PVEP) and thickness of quadrants of the macula (TQM) using optic coherence tomography (OCT). MATERIALS AND METHODS: According to polysomnography examinations, 30 mild, 30 severe, 30 controls were included in the study after approval from the ethics committee. RESULTS: No significant difference was found in age and gender between the groups (p = 0.184 and p = 0.954). Significant difference was found between external and internal superior TQM, mean thickness of ganglion cell layer in comparison of all three groups (p = 0.011, p = 0.047, p = 0.030). In comparison between severe OSAS and control groups, significant difference was found in internal nasal, internal superior and external superior TQM (p = 0.048, p = 0.033, p = 0.014) while no significant difference was found TQM in comparison between the mild OSAS and control groups. In comparison between the group of severe OSAS and controls, significant increase was found in P100 as well as N145 latencies whereas only P100 latency was found to increase when mild OSAS was compared with controls. No significant correlation was found between TQM and PVEP parameters in mild and severe OSAS patients. DISCUSSION: Latency and amplitude of PVEP altered in OSAS because edema and inflammation was remarkable in mild as well as severe stages of the disease. Furthermore, thinning in the macula was observed only in severe stages of the disease, explained with level of atrophy and exposure to extended hypoxia.

Evaluation of effects of positive airway pressure treatment on retinal fiber thickness and visual pathways using optic coherence tomography and visual evoked potentials in the patients with severe obstructive sleep apnea syndrome.

INTRODUCTION: Hypoxia during sleep in obstructive sleep apnea syndrome (OSAS) increases intracranial pressure, decreases cerebral perfusion pressure, and alters vascular supply to the optic nerve. Pattern visual evoked potential (pVEP) has revealed that it causes alterations in the optic nerve, and optic coherence tomography has shown that it causes alterations in the retinal and macular layers. OBJECTIVES: To detect and compare possible alterations in macula and peripapillary retinal nerve fiber thickness (pRNFL) using OCT and in the optic nerve pathways using pVEP before and after positive airway pressure (PAP) in the patients with severe OSAS. MATERIALS AND METHODS: Thirty patients who were diagnosed as having severe OSAS in the neurology-sleep outpatient clinic and 30 healthy control subjects were included in the study. Ophthalmic examinations were performed prior to (month 0) and after (month 6) PAP treatment, and pVEP (peak time [PT] and amplitude) and OCT parameters (peripapillary retinal-macular layers) were compared. RESULTS: In the comparison between the severe OSAS (before treatment) and control groups, thinning was found in pRNFL (average, nasal, inferior) and in the macular layers (external and internal superior quadrants) (p < 0.05). pVEP investigation revealed increased PT in P100 and N145 waves and decreased amplitude of N75-P100 waves. In the comparisons before and after PAP treatment, a decrease in PT of N75 and P100 waves and increase in N75-P100 amplitudes were found. In the pRNFL, significant thickening was found in the layers with thinning before treatment, whereas no significant thickening was found in macular layers, except for the fovea. DISCUSSION: It was shown that PAP treatment in patients with severe OSAS prevents hypoxia without causing alterations in intraocular pressure and thus reduces inflammation and causes thickening in the pRNFL and macular layers.

Evaluation of retinal fiber thickness and visual pathways with optic coherence tomography and pattern visual evoked potential in different clinical stages of obstructive sleep apnea syndrome.

PURPOSE: To investigate the possible changes in retinal nerve fiber layer (RNFL) by optic coherence tomography and in the amplitudes and peak times (PTs) in pattern visual evoked potential (pVEP) and to compare them in obstructive sleep apnea syndrome (OSAS). METHODS: This prospective study included patients with mild OSAS (n = 30), severe OSAS (n = 30), and 30 control subjects. All patients were assessed after obtaining the approval from our hospital's ethics committee. RESULTS: There was no difference in age and gender between the groups (p = 0.184, p = 0.954). By analysis of variance, there was a significant difference in RNFL values among patients with mild OSAS, severe OSAS, and control for three measures of RNFL (average p = 0.044, nasal p = 0.003, inferior p = 0.027). In severe OSAS group, nasal and inferior quadrants of the RNFL were found to be thinner than the control group (p = 0.008, p = 0.031). We showed that the PT of P100 and N145 was prolonged in severe OSAS compared to the control group (p < 0.001) and that PT of P100 was prolonged in mild OSAS compared to the control group (p < 0.05). The amplitude of N75-P100 was significantly decreased in patients with both severe OSAS and mild OSAS compared to the control group (p < 0.001). Correlation of RNFL and pVEP values showed that the inferior quadrant RNFL thickness is correlated with both P100 and N145 PTs (r = 0.271*, p = 0.036 and r = 0.290*, p = 0.043, respectively) and N75-P100 amplitude (r = 0.378**, p = 0.003) in severe OSAS group. CONCLUSIONS: In mild and severe stages of the disease, edema and inflammation were evident and VEP PT and amplitudes were affected in both groups. Furthermore, thinning in RNFL in the severe stage of the disease might be associated with higher atrophy levels and prolonged exposure to hypoxia.

CADASIL with Atypical Clinical Symptoms, Magnetic Resonance Imaging, and Novel Mutations: Two Case Reports and a Review of the Literature.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary microangiopathy with adult onset caused by a missense mutation in the NOTCH3 gene in chromosome 19p13. It presents with autosomal dominant arteriopathy, subcortical infarctions, and leukoencephalopathy. Its common clinical presentations are seen as recurrent strokes, migraine or migraine-like headaches, progressive dementia, pseudobulbar paralysis, and psychiatric conditions. Two patients with CADASIL syndrome, whose diagnosis was made based on clinical course, age of onset, imaging findings, and genetic assays in the patients and family members, are presented here because of new familial polymorphisms. The first patient, with cerebellar and psychotic findings, had widespread non-confluent hyperintense lesions as well as moderate cerebellar atrophy in cranial magnetic resonance scanning. The other patient, with headache, dizziness, and forgetfulness, had gliotic lesions in both cerebral hemispheres. CADASIL gene studies revealed a new polymorphism in exon 33 in the first patient. In the other patient, the NOTCH3 gene was identified as a new variant of p.H243P (c.728A > C heterozygous). By reporting a family presenting with various clinical symptoms in the presence of new polymorphisms, we emphasize that CADASIL syndrome may present with various clinical courses and should be considered in differential diagnoses.

Evaluation of visual pathways using visual evoked potentials in the patients with impaired fasting glucose and impaired glucose tolerance.

PURPOSE: There are many studies on degeneration of the ganglion cells using visual evoked potential (VEP) in Diabetes mellitus (DM). The present study intended to investigate whether the retinopathy findings would be helpful for detecting the degeneration to develop or not in retinal ganglion cells with the VEP test before being detectable in ophthalmoscopic examination on prediabetic patients. MATERIALS AND METHODS: The present study was conducted prospectively after obtaining approval from the Ethics Committee. In our study, the subjects were divided into three groups as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and normal patients. They also underwent physical, ophthalmological and VEP examination. Three main components of VEP obtained from these groups were N75, P100, and N145 latency and N75-P100 amplitude. RESULTS: The study participants consisted of the IFG group (n: 30, female/male ratio: 21/9; mean age: 49.17 ± 10.52 years), the IGT group (n: 30, female/male ratio: 23/7; mean age: 47.00 ± 11.09 years), and the Control Group (n: 40, female/male ratio: 30/10; mean age: 48.03 ± 10.96 years). Difference in sex and age between the study groups (p > 0.05). P100 latency was found to increase significantly in comparison between the IGT and Control Group for both eyes (p right: 0.003, p left: 0.001) whereas it did not increase significantly in the comparison between the IFG and the Control Group (p right: 0.065, p left: 0.116). CONCLUSION: It was observed that VEP may be a parameter of predictive value that might be used in evaluating prediabetic cases in terms of retinopathies similar to DM.

Are Herniated Cerebellar Tonsils the Main Culprit of Chiari Malformation Type I Symptoms? The Brainstem Compression Hypothesis seems to be Re-Elucidated and Revised.

AIM: The Chiari Malformation I (CM I) and the tethered cord syndrome (TCS) are both congenital abnormalities whose mechanisms are still not fully understood. The association of CM I and TCS has been reported only a few times previously. MATERIAL AND METHODS: This retrospective study included 7 patients who were diagnosed with CM I and TCS, managed by cutting of the filum terminale. RESULTS: The mean follow-up period was 21 months and 28 days. Although all patients underwent an untethering surgical procedure by cutting the filum terminale only, all patients reported significant early postsurgical resolution of CM I symptoms and symptoms related to TCS as well. CONCLUSION: Patients with symptomatic CM I, even if lumbar MRI is normal and the patient asymptomatic for TCS, may have tethered spinal cord at the same time. It seems it would be worthwhile to investigate CM I patients for occult TCS with spinal somatosensory evoked potentials.

Association of myasthenia gravis and Behçet's disease: A case report.

Myasthenia gravis is a disease of neuromuscular junction due to auto-immune destruction of the acetylcholine receptors. Behçet's disease, on the other hand, is a multisystemic vascular-inflammatory disease. Both conditions are not common in the general population although their association has not been reported in the literature. We wanted to present our patient who developed clinical course of myasthenia gravis following discontinuation of medications due to complications of corticosteroid for Behçet's disease. It was observed that clinical findings of myasthenia gravis recovered following restarting steroid treatment and he did not experience attacks of both conditions. Although Myasthenia gravis and Behçet's disease are distinct entities clinically as well as in terms of pathogenesis, they share common physiopathological features and their treatment is based on their common features.

Evaluation of neurodegeneration through visual evoked potentials in restless legs syndrome.

Restless legs syndrome (RLS) is a disease characterized by some type of dysesthesia, an indescribable abnormal sensation in the extremities. Our objective was to determine whether the visual evoked potentials (VEP) can be used as a quantitative monitoring method to evaluate demyelination-remyelination and neurodegeneration in the patients with RLS. The present study was carried out prospectively. It was planned to determine normal or pathological conditions in the form of increased latency or decreased amplitude of VEP and to evaluate possible pathologies in the visual and retinal pathways at early stages and at months 3 and 6 of follow-up in the patients with RLS (with or without iron deficiency anemia), in those without RLS (at the time of diagnosis prior to any medical therapy) without any visual symptoms. It was observed that latency of VEP improved but didn't return to normal limits following treatment with dopamin agonists, iron, or combination of both and that there was no significant difference between the post-treatment data and those of the control group. These results in combination with the fact that the latencies and amplitudes didn't return to normal levels despite the 6-month-treatment but showed a progressive course with partial regeneration suggests that there was incomplete remyelination. It should be kept in mind that this syndrome is likely to be a part of neurodegenerative process.

Scoliosis may be the first symptom of the tethered spinal cord.

BACKGROUND: Tethered cord syndrome (TCS) is a progressive clinical entity that arises from abnormal spinal cord tension. Scoliosis may be a unique symptom in TCS. The aim of this study is to investigate prognosis after releasing the filum terminale in scoliosis due to TCS with/without findings in magnetic resonance imaging (MRI) and to draw attention to the importance of somatosensorial evoked potentials (SSEP) on the differential diagnosis of idiopathic scoliosis versus scoliosis due to TCS with normal appearance of filum terminale and conus medullaris. MATERIALS AND METHODS: Eleven female and seven male patients with progressive scoliosis were included in the study. They were evaluated radiologically, SSEP and urodynamical studies. Preoperative and postoperative anteroposterior full spine X-rays were obtained for measuring the Cobb's angle. MRI was performed in all cases for probable additional spinal abnormalities. All patients underwent filum terminale sectioning through a L5 hemilaminectomy. The resected filum terminale were subjected to histopathological examination. RESULTS: The mean Cobb angle was 31.6° (range 18°-45°). Eight patients (44.45%) had a normal appearance of filum terminale and normal level conus medullaris in MRI, but conduction delay and/or block was seen on SSEP. In the histopathological examination of filum terminale dense collagen fibers, hyaline degeneration and loss of elastic fibers were observed. Postoperatively none of the patients showed worsening of the Cobb angle. Three patients showed improvement of scoliosis. CONCLUSION: In TCS presented with scoliosis, untethering must be performed prior to the corrective spinal surgery. Absence of MRI findings does not definitely exclude TCS. SSEP is an important additional guidance in the diagnosis of TCS. After untethering, a followup period of 6 months is essential to show it untethering helps in stopping the progress of the scoliotic curve. In spite of non progression (curve stopped lesser than 45°) or even improvement of scoliosis, there may be no need for major orthopedic surgical intervention.

Tethered Cord Syndrome in Adults: Experience of 56 Patients.

AIM: The aim of this study was to describe the results of surgery performed in a group of adult patients with tethered cord syndrome with their outcomes. MATERIAL AND METHODS: This retrospective study included 56 patients. There were 38 females and 18 males. All patients were older than 18 years. RESULTS: The mean age at referral was 36 years and 1 month. The mean follow-up period was 10 months 27 days. 95% of all patients with back and leg pains improved and 5% remained the same. Three patients with motor deficits remained the same in the postoperative period. Of the 16 patients with urological complaints, 10 improved, 5 unchanged and 1 patient died in the postoperative first day due to pulmonary embolism. CONCLUSION: The syndrome of tethered cord may be a situation to be treated even in the elderly in case of normal level conus medullaris and filum terminale with a normal appearance as well as a low-lying conus and thick filum. To prevent overlooking the diagnosis of tethered cord and/or unnecessary spinal surgeries, the tethered cord syndrome should be remembered in the differential diagnosis list in the presence of back and leg pains, neurological deficits or urological complaints.

Cutting filum terminale is very important in split cord malformation cases to achieve total release.

AIM: Split cord malformations (SCMs) are rare congenital anomalies of the vertebrae and the spinal cord. Tethered cord syndrome (TCS) is a clinical condition of various origins that arises from tension on the spinal cord. Radiographic findings may include and/or associate split cord malformations and the other neural tube defects. However, the spinal cord can even be tethered by a filum terminale with normal appearance and normal level conus medullaris in magnetic resonance imaging (MRI). The aim of our study is to show whether SMC patients with normal or abnormal MRI findings had all histological abnormal filum terminale and also to show that the standard SCM repairing operation without cutting filum will not achieve total release. MATERIAL AND METHODS: We have reviewed 33 SCM patients between July 2005 and December 2013. They were operated by adding untethering procedure of filum terminale following standard surgical intervention, and a part of the filum was taken for histopathological examination even though MRI did not show the presence of abnormality of filum terminale. RESULTS: We found that abnormal filum terminale with a normal appearance may had dense collagen fibers, wide and numerous capillaries, and hyaline formation, while normal filum terminale is a mixture of collagen fibers and blood vessels. We did not obtain positive Verhoeff elastic fiber staining. The elastic fibers had disappeared in all fila terminalia, except control cadaver group. CONCLUSION: Our results showed that all fila of SCM patients had loss of elastic fibers and increased of hyalinization, which means loss of elasticity of filum terminale. Less severe traction may remain asymptomatic in childhood and present with neurological dysfunction later in life. For this reason, surgical procedure of SCM patients including releasing of filum terminale seems more beneficial for the patients and be better for long term.

Evaluation of the effects of mobile phones on the neural tube development of chick embryos.

AIM: The objective of this study is to examine the effects of radiation of mobile phones on developing neural tissue of chick embryos. MATERIAL AND METHODS: There were 4 study groups. All Groups were placed in equal distance, from the mobile phones. Serial sections were taken from each Group to study the neural tube segments. RESULTS: The TUNEL results were statistically significant (p < 0.001) at 30 and 48 hours in the third Group. We found low Bcl-2 levels partly in Group 4 and increased activity in Group 3. Caspase-3 was negative in the 48 and 72 hours in the Control Group, had moderate activity in the third Group 3, weak activity in the 48 hour, and was negative in the 72 hour in other groups. Caspase-9 immunoreactivity was weak in Group 1, 2 and 3 at 30 hours and was negative in Group 1 and 4 at 48 and 72 hours. Caspase-9 activity in the third Group was weak in all three stages. CONCLUSION: Electromagnetic radiation emitted by mobile phones caused developmental delay in chick embryos in early period. This finding suggests that the use of mobile phones by pregnant women may pose risks.

Preoperative and postoperative evaluation of somatosensorial evoked potentials of upper extremities in cervical intervertebral disc herniation.

This study aims to determine the dysfunction caused by existing pathological condition in structures involved in the transfer of sensory functions of the neural system in cervical disc herniation, and to establish whether or not the level and degree of this anatomical damage can be anticipated by SEP (Somatosensorial Evoked Potentials). We compared the obtained SEP values for statistical significance using the Friedman Variation Analysis. In parameters with statistical significance, the Wilcoxon Signed Rank test was used to identify when significant improvements occurred. The study found that the statistical data of the latency of the N14 wave originating from the dorsal column nuclei of the medulla spinalis and dorsal column gray matter improved (p < 0.05) in the postoperative period compared with the preoperative values. Using the Wilcoxon Signed Rank test, we studied postoperative months separately in regard to the difference in the latency of the N14 wave, and found the statistically significant improvement to be marked particularly in months 3 and 6 postoperatively (p < 0.05). In conclusion, we suggest that SEP is a useful tool to check the functional condition of the dorsal spinal column. The benefit of the SEP utilization is the ability to determine the severity of the pathological condition preoperatively and follow the patient's functional postoperative improvement.

Urinary incontinence triggered by stretching exercises.

A 47-year-old female patient who experienced urinary urgency after having stretching exercises of her legs is presented. Stretching of the legs are thought to be responsible for conus medullaris tethering which in turn causes urinary complaints. What is interesting in this case is that her complaints about urinary urgency stopped as she quit stretching exercise movements of her legs. There are some examples of such cases in the literature. The urinary urgency after stretching exercises warned us to investigate this patient in regard to tethered conus medullaris. Tethering of the conus medullaris can be temporary and can cause reversible functional disorders of the bladder. Incontinence at any age should be evaluated cautiously as it could be a sign of an underlying important developmental failure.

Inappropriate surgical interventions for midline fusion defects cause secondary tethered cord symptoms: implications for natural history report of four cases.

INTRODUCTION: The causes of tethered spinal cord are various. In order to release the tethering effect of these malformations, the surgical interventions must include removal of all tethering components, reconstruction of the neural tube and sectioning of tight filum terminale as well. CASES: The cases reported in this paper have had an operation many years before for various developmental defects. After a certain period of time (5-10 years) of the first operation, the patients reapplied to the hospital with various symptoms of spinal cord tethering, either vertical or horizontal. DISCUSSION: At surgical intervention, it was noted that inappropriate surgical procedures caused retethering of the spinal cord in all patients. Postoperative period of all patients were uneventful. All patients declared relief in their symptoms. We would like to draw attention that untreated (or inappropriately treated) midline developmental defects will invariably cause syndrome of tethered cord. Consequently, prophylactic surgical untethering must be applied to all patients with developmental midline defects as soon as possible. CONCLUSION: It looks that tethered cord symptoms invariably appear as enough negative influence accumulates as the time passes. Elapsed time may vary but unpleasant end result invariably arrives. While these cases with tethered spinal cord develop progressive neurological symptoms, prophylactic and appropriate surgical intervention should be considered as early as possible. There is no acceptable rationale to wait for the appearance of tethered cord syndrome symptoms to perform surgical untethering of the spinal cord because of the probability of irreversibility of the symptoms (incontinence of urine in particular) of tethered spinal cord syndrome.

Adult tethered cord syndrome mimicking lumbar disc disease.

OBJECT: This paper reports four tethered cord cases who initially applied with lumbar disk disease symptoms. MATERIALS AND METHODS: All of them were investigated by magnetic resonance imaging (MRI) and somatosensory evoked potential (SSPE). In two patients, MRI revealed thick and fatty filum terminale, while in remaining two, the filum terminale appeared as normal in thickness. SSEP revealed pathological conduction values in all, and it was the main indicator for surgical sectioning in patients especially with normal MRI investigations. All patients had benefit from the surgical sectioning of the fila terminalia with either thick and fatty or normal appearance. CONCLUSION: A particular patient with lumbar disc disease symptoms having normal MRI should also be investigated for tight filum terminale. If there is no pathological appearance in MRI investigation (both in regard to disc herniation and thick and fatty filum terminale), SSEP investigation should be done to check whether a conduction block or delay is present, indicating cord tethering.