14. Surgical complications were generally minor. This allows the covering of the spinal cord to seal so Surgery is the only treatment for tethered cord. After identification of the terminal filum, we confirmed electromyography activity on bipolar stimulation before clip ligation and definitive sectioning. It may not be possible for the syrinx to be fully removed, so the goal of surgery may be . Epub 2018 Mar 8. In a baby with Spina bifida the spinal cord is still attached to the skin around it preventing it from rising properly. Cauda equina was managed by sharp releasing adhesion under the nerve electrophysiological monitoring, tumors were removed with the use of medical ultrasonic dissector.
Tethered cord syndrome in adults - PubMed Refer a Patient. Fourteen patients (37.712.5 years) with TCS were enrolled at 6 hospitals. 4. 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. Pain or anti-inflammatory medication. Long-term surgical results and patient outcome ratings were encouraging. dispersed camping roosevelt national forest, approach to pancytopenia in pediatrics ppt, cedar ridge high school basketball roster, private landlords in garfield heights ohio, que pasa cuando los dos amantes son casados, margot robbie samara weaving and jaime pressly, how to broadcast party chat on twitch xbox one, illinois state law on medication administration, purpose of short service line in badminton. Objective To evaluate the surgical treatment of tethered cord syndrome (TCS), a prospective analysis of 43 patients operated at Neurosurgery Department Zagazig University hospitals from May 2013 to January 2017 with 1 year follow-up had been done. 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. Surgery may be difficult, and is always accompanied by WebFollowing a tethered cord release surgery, children are typically discharged in 1-2 days after surgery.
Adult Tethered Cord The authors prefer to limit bathing to a sponge bath until the patient is seen in clinic 1 week later. A post-traumatic tethered cord can occur . 7
Surgical Treatment of Tethered Cord Syndrome in Adults The .gov means its official. An official website of the United States government. 10. All the 82 cases of patients received nerve electrophysiology monitoring assisted microsurgery. The mean age of the patients was 46 13 years (range 23-74 years) and the mean follow-up duration was 61 62 months. The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. [2] The tumor compression of the cone and the tail is one of the main causes for the tethered cord.
Tethered Spinal Cord Syndrome Causes, Diagnosis and Treatments 2007 Mar;6(3):210-5. doi: 10.3171/spi.2007.6.3.210. 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. The average length of spine shortening was 23.3 mm.
The tethering effect was caused either by a split cord malformation, a thick filum terminale, a conus medullaris lipoma with extradural extension, or various combinations of these mechanisms. Postoperative bony fusion was confirmed in all patients with SSO by analysis of computed tomography reconstruction images at 1year after surgery. Shukla M, Sardhara J, Sahu RN, Sharma P, Behari S, Jaiswal AK, Srivastava AK, Mehrotra A, Das KK, Bhaisora KS. Web Spinal cord tethering may be either primary or secondary.
Spinal Cord Tethering Surgeries were performed under continuous electrophysiologic neuromonitoring with somatosensory-evoked potentials, combined with motor-evoked potentials, and electromyography with direct nerve root stimulation. 17. [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.
Tethered Cord Release | Winchester Hospital J Neurosurg Spine. Based on this small retrospective case series, SSO appears to provide clinical improvement at least comparable to the untethering procedure, especially in more challenging cases. 7 Over time, the term ''tethered cord'' has been . When surgeons operate around the spinal cord, the area where the CSF lies is opened so they can untether the spinal cord. Neurosurg Focus. Log in now and start reading! A tethered cord release reduces or removes the . HHS Vulnerability Disclosure, Help Yamada S, Lonser R R. Adult tethered cord syndrome. Abnormal tissue, growth, tightening, or thickening of tissue can make it hard to move the spinal cord. 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. . HHS Vulnerability Disclosure, Help This way, the care team can best assess your childs condition at their first appointment. And if you do have to take laxatives - just go ahead and do that. Socio de CPA Ferrere.
Tethered Spinal Cord: What It Is, Symptoms & Treatment Adult tethered cord syndrome. We are committed to providing expert caresafely and effectively.
Comparative Study of Untethering and Spine-Shortening Surgery 9 Patients with such complex pathologies have been found to have a 9 to 50% chance of worsening pain and sensorimotor deficits after untethering.7 Unlike pediatric patients, adults experience degenerative changes that further complicate treatment.5 6. We conducted a retrospective multicenter study. The https:// ensures that you are connecting to the Physical therapy. Nineteen (86%) of 22 employed patients returned to work after surgery. The mean operation time was 220.2 109.0 minutes for untethering surgery and 399.5 9.6 minutes for SSO; as these numbers clearly indicate, the time was significantly longer for the SSO group ( p = 0.01). However, his condition subsequently deteriorated, and he could not walk by himself 1year after untethering surgery. Analysis was performed according to Hoffman grading system. Given radiographic findings of tethered cord syndrome and clinical symptoms of pain, UTIs, urinary retention requiring catheterization, and constipation, it was recommended that the patient undergo untethering of the spinal cord via sectioning of the fatty filum terminale. 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). As the child grows taller, the spinal cord is stretched. Features of the condition may include foot and spinal abnormalities; weakness in the legs; loss of sensation (feeling) in the lower limbs; lower back pain; scoliosis; and urinary incontinence. [7] Significantly different from children with TCS, there was also the existence of incentives in adult patients with TCS, such as hip hyperflexion due to high falling injury, lithotomy position delivery, long-time sitting causing over stretching of the spinal cord, all of which might evoke the development of TCS.[8]. Then, the care team will confirm the tethering of the spinal cord through a spine MRI. 7 Phi J H, Lee D Y, Jahng T A, Chung C K, Kim H J. Tethered cord syndrome in adulthood: reconsidering the prognosis. Adult intradural lipoma with tethered spinal cord syndrome. Complications include infection, bleeding, and damage to the spinal cord or myelomeningocele, which may result in decreased muscle strength or bladder or bowel function. 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. The summary of outcomes from previous reports (Table 4) shows that the improvement of symptoms after surgery was more frequently observed with SSO. A representative case of spine-shortening osteotomy. [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. [2], Dermoid cyst should be completely removed together with cyst wall as much as possible, cystic wall residue is easy to cause the recurrence of cyst, although decreased volume of cyst can relieve the symptom of tethered, characteristics of dermoid cyst may lead greater possibility to TCS than lipoma. Generally, although surgical invasiveness is greater with SSO, this procedure could be considered as a viable alternative to untethering surgery in complicated adult TCS cases. JG, XK, and ZL have contributed equally to the article.
Neurological outcome after surgical management of One patient in the untethering surgery group underwent SSO because the symptoms worsened 1year after untethering. Abstract. This causes extra stress on the nerves and can cause a range of symptoms known as tethered cord syndrome. Kenyu Ito, none The surgical procedure performed at L1 is described below. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. WebRecurrent tethered cord syndrome (TCS) can lead to significant progressive disability in adults. This can cause the spinal cord to stretch out as the spine grows, leading to possible nerve damage, pain and other symptoms. Four patients (29%) underwent prior surgery for myelomeningocele repair during infancy, 2 (18.2%) in the untethering group and 2 (66.7%) in the SSO group; 1 of these 4 patients underwent untethering surgery at 7 years of age.
8 Figure 1A shows a 37-year-old male patient with a lumbar spinal lipoma at L3/L4 level. Because neurological deficits are generally irreversible, early surgery is recommended. Typically, there is also a short filum and, as a result of both anomalies, a tethered cord. All patients underwent surgery. 714-509-7070. The mean operation time was 220.2109.0 minutes for untethering surgery and 399.59.6 minutes for SSO; as these numbers clearly indicate, the time was significantly longer for the SSO group (p=0.01). [2] As for normal embryo under 20 weeks, the termination of spinal cord was located at the level of L4 to L5, and at the level of L3 under 40 weeks, when the baby was born, it was located at the level of L1 to L2. An adult tethered cord syndrome has also been described. 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. bDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA. Long-term results showed a good prognosis in patients in whom first-time (that is, nonrevision) surgery achieved successful untethering, with a 10-year rate of neurological stabilization in 89% of Group A and a 10-year rate of neurological stabilization in 81% of Group B patients. . (C) Postoperative lateral radiograph 3 years after surgery shows complete bone union and significant spine shortening. Untethering (tethered cord release) is the gold standard treatment for TCS. Before It is not a substitute for medical advice and should not be used to treatment of any medical conditions. 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). Hertzler DA 2nd, DePowell JJ, Stevenson CB, et al. Tethered cord syndromea study of the short-term effects of surgical detethering on markers of neuronal injury and electrophysiologic parameters. 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. Object: Although postsurgical neurological outcomes in patients with tethered cord syndrome (TCS) are well known, the rate and development of neurological improvement after first-time tethered cord release is incompletely understood. Symptoms of Tethered Spinal Cord Syndrome in Teens and Adults. 15. 10 Some patients may be misdiagnosed as having sciatica, a more common source of lower back . Surgery to detach the spinal cord from the sheath. 8 A tethered cord may go undiagnosed until adulthood when sometimes complex and severe symptoms come on slowly over time. Review of the literature]. Tethered cord syndrome (TCS) is basically a condition where anchorage of a part of the spinal cord, most commonly the area of the conus, by some inelastic structure, which results in functional dysfunction involving the adhered segment of the spinal cord or at times segments beyond that. Data is temporarily unavailable.
tethered cord surgery in adults recovery time 2 Adults. Let us help you navigate your in-person or virtual visit to Mass General. A total of 32 consecutive adult patients underwent untethering surgery for secondary tethered cord syndrome in our department from January 2008 until December 2018. Through the follow-up of 56 cases of adult TCS patients, Httmann et al[9] found that the pain relief rate was 86%, which was the most obvious symptoms that alleviated, remission rate of the lower limb spasticity was 7l%, and the remission rate of bladder dysfunction and feeling movement dysfunction was 44% and 35%, respectively. [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. For patients treated conservatively, follow-up information could be obtained in 33 of 42 patients. Abstract. This site needs JavaScript to work properly. Unauthorized use of these marks is strictly prohibited. 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). Tethered cord syndrome: a review of the literature from embryology to adult presentation. Two (33%) of six patients who were not employed before surgery worked full time postoperatively. 2017;2017:5364827. doi: 10.1155/2017/5364827. Then, temporary rods were fixed in place for column stability while we performed the osteotomy. Methods: All patients were followed up, no death occurred. Changes of symptoms were associated with the course of disease; patients with relatively shorter disease course were shown to have a mild Hoffman grading, whereas patients with relatively longer disease course were indicated to have a severe Hoffman grading. Lew SM, Kothbauer KF. The spinal cord tension was relieved after surgery as shown by preoperative MRI. WebWhat happens after tethered spinal cord surgery? Maurya VP, Rajappa M, Wadwekar V, et al. Tethered cord syndrome (TCS) is a neurologic disorder caused by abnormal traction of the spinal cord resulting from several pathologic conditions: thickened filum terminale, meningocele, lipomyelomeningocele, and split cord malformation.1 As an alternative to untethering, Kokubun et al introduced spine-shortening osteotomy (SSO) for patients with TCS caused by a lipomyelomeningocele.11 SSO reduces the tension in the spinal cord and minimizes the perioperative complications.10 Tethered cord syndrome (also called fastened cord syndrome) is a condition in which the spinal cord is not able to float freely within the spinal column because of an abnormal (unusual) attachment to tissue surrounding it. Prompt surgical treatment is often necessary to avoid permanent sequelae. flag football tournaments 2022 tethered spinal cord surgery recovery time. Miyakoshi N, Abe E, Suzuki T, Kido T, Chiba M, Shimada Y. Spine-shortening vertebral osteotomy for tethered cord syndrome: report of three cases. 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan, 2Department of Orthopedic Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan, 3Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan, 4Department of Orthopedic Surgery, Konan Kosei Hospital, Aichi, Japan, 5Department of Orthopedic Surgery, Aichi Medical University, Aichi, Japan, 6Department of Orthopedic Surgery, Hamamatsu Medical University, Shizuoka, Japan. You will have many questions about the disorder, and we are here to answer them. 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. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. What is Adult Tethered Cord? Funding/support: This study was supported by Peking Union Medical College Youth Research Funds (2016) (project no. 9 The patient was followed up for 2 years without local recurrence. 3 2004 Aug;62(2):127-33; discussion 133-5. doi: 10.1016/j.surneu.2003.11.025. After untethering surgery, CSF leakage, neurologic deterioration, hematoma, difficult wound healing, and meningitis have been reported (Table 5).1 4 Postoperative Orders . 11. Would you like email updates of new search results? Hoffman HJ, Hendrick EB, Humphreys RP. 2012 Sep;17(3):199-211. doi: 10.3171/2012.5.SPINE11904. Garceau GJ. Be so glad you have been diagnosed with tethered cord at a young age. By the time of birth the spinal cord is located between L1 and L2. Application of microsurgical technique for intraspinal lipoma tethered cord syndrome: report of 611 cases. Medicine (Baltimore). One of the most common complications related to this surgery is wound infection, especially if the incision (cut into the skin) is made around the low back. Perioperative complications are another concern in adult TCS. 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. [4] In 1953, Garceau described the filum terminal syndrome, suspected that the tensive filum terminal pulled the spinal cord might cause defecation dysfunction and other symptoms. Neurosurgery. Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. There are different types of tethered cord. In some children who have tethered cord syndrome, they may lose control of their bladder or bowels. [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. (D) Postoperative sagittal T2-weighted MRI scan obtained 1year after surgery. Post-operative radiotherapy for recurrent dermoid cysts of the spine: a report of 3 cases. In this study, we evaluated the feasibility of BCR monitoring during untethering surgery in infants and children to predict postoperative urinary and bowel dysfunction. WebHave you lie flat on your back for up to 72 hours to prevent cerebrospinal fluid from leaking around the spinal cord During your stay, the hospital staff will take steps to lower your Bookshelf Moreover, complications, such as cerebrospinal fluid (CSF) leakage and neurologic deterioration, have been frequently reported.1 At present, the classification of lipoma-oriented TCS is confused, Arai et al[15] had classified it into 5 different kinds, including the dorsal, caudal, combined, filar, and lipomyelomeningocele; while it was subdivided into the lower conical, lateral conical, and upper conical by Wang et al. August 2017. This means a shorter, Walk on their own (if appropriate for age), Diazepam (Valium) to prevent muscle spasms. Chapman P H. Congenital intraspinal lipomas: anatomic considerations and surgical treatment. Treatment of posttraumatic syringomyelia. The site is secure. J Surg Case Rep. 2020 Mar 24;2020(3):rjaa041. 9 [20] Therefore, early diagnosis and early surgical treatment will be possible to obtain a better prognosis for patients with symptomatic adult TCS. eCollection 2020 Mar. The site is secure. where is winter the dolphin buried; forest management plan maryland During this call, the nurse will help decide which type of anesthesia is best for your child and if your child may have any risks with anesthesia. Your child will also need a COVID-19 PCR test 48 hours (2 days) before surgery. The next day, your child sit up and the care team will check whether your child has a headache. Her curves when checked were Top - 23 and bottom - 23. Duraplasty using substitute materials was performed at the close of surgery. Intraoperative feasibility of bulbocavernosus reflex monitoring during untethering surgery in infants and children. For most children who have tethered cord surgery, their symptoms do not progress or get worse. Clinical improvement 1 year after surgery in our study showed back pain improvement in 60% of children and 75% of adults, parathesia improved in 60% of
tethered cord surgery in adults recovery time Iskandar BJ, Oakes WJ, McLaughlin C, Osumi AK, Tien RD. Garceau theorized that tension on the . 5 The care team is well educated in providing pain management options based on the Enhanced Recovery After Surgery (ERAS) protocol. 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, 5 The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies. The clinical records were reviewed for preoperative symptoms, duration of symptoms, complications, and neurologic improvements. The nurse will help schedule the COVID-19 PCR test. 11 Miyakoshi et al reported complete clinical recovery without complications in 2009, which led to the hope that SSO would be the way to reduce perioperative complications and provide better neurologic outcomes.10 Although Kokubun et al also reported good clinical results after SSO in 2011,11 there have been no reports until now of a comparative study or review of these two procedures. Webtom kenny rick and morty characters. Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work. Nakashima H, Imagama S, Matsui H, Yukawa Y, Sato K, Kanemura T, Kamiya M, Ito K, Matsuyama Y, Ishiguro N, Kato F. Global Spine J. 2021 Feb 16;88(3):637-647. doi: 10.1093/neuros/nyaa491. Loss of bowel and bladder control. HOB, positioning, activity, bathing: The patient is kept flat on bed rest for 3 days to allow for dural healing and to put as little CSF pressure on the dura as possible during this time. Surg Neurol. All patients were followed up, no death occurred. Tokumi Kanemura, none After exposing the dura mater spinalis, it was cut from the normal anatomical structure to the lesion.
Adult Tethered Cord Syndrome | UCLA Health Red flags that might lead a doctor to suspect tethered cord include any of its symptoms (although the same symptoms can be caused by a number of other spinal cord conditions); a previous diagnosis of a congenital spinal malformation; a history of cancer, infection, spine surgery; or spinal cord injury. To investigate effects of surgical treatment on adult tethered cord syndrome (TCS). Symptoms may include back pain that radiates to the legs, hips, and the genital Epub 2012 Jul 13. WebThe dysfunction of nervous system in Cases 1, 2, and 4 disappeared within 3 weeks. 2014; 192:221-7. . WebIntroduction. Bulbocavernosus reflex (BCR) monitoring is used to assess the integrity of urinary and bowel function. As with any surgery, tethered cord surgery has risks and complications. The child usually can resume normal activities within a few weeks. Definition. Dallas. The https:// ensures that you are connecting to the Recovery The authors reviewed their institutional experience with the surgical management of adult TCS to assess the time course of symptomatic improvement, and to . A retrospective analysis of 82 adult patients with TCS treated by surgery was conducted between March 2005 and December 2015 in Peking Union Medical College Hospital. 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. The tethered spinal cord is developed by the following ways: A . to analyze our web traffic. Depending on the type of tethered cord your child has, they may be more at risk for re-tethering (when the spinal cord reattaches to tissue). 8600 Rockville Pike Yamada S, Won D J, Pezeshkpour G. et al. Learn about career opportunities, search for positions and apply for a job. (A) Preoperative lateral radiograph. The care team will review your childs symptoms and how tethered cord syndrome is affecting their quality of life. 15 Meanwhile, a history of prior surgery and complex preoperative categories of tethering lesions are also risk factors for worse clinical outcomes.7 20. 19-42. . Asian J Neurosurg. Stetler WR Jr, Park P, Sullivan S. Pathophysiology of adult tethered cord syndrome: review of the literature.
Surgery (A) A 37-year-old male patient with a lumbar spinal lipoma at L3/L4 level. 19. . Muscle weakness was present in 10 patients (71%), 8 (57%) had leg pain and sciatica, and 6 (43%) had back pain. WebSpray Foam Equipment and Chemicals. 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. Lumbosacral laminectomies were performed to obtain adequate exposure of the conus medullaris and cauda equina. Milano JB, Barcelos ACES, Onishi FJ, Daniel JW, Botelho RV, Dantas FR, Neto ER, de Freitas Bertolini E, Mudo ML, Brock RS, de Oliveira RS, Joaquim AF. The diagnosis of TCS is made with a high degree of clinical suspicion. 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. Surgery was recommended for patients with symptoms only. Horrion J, Houbart MA, Georgiopoulos A, et al. But previous investigation estimated that no more than 40% of dermoid cyst could be completely removed. Comparative Study of Untethering and Spine-Shortening Surgery for Tethered Cord Syndrome in Adults. These back pains were treated conservatively with oral analgesic agents. Congenital tethered spinal cord syndrome in adults. 7 With a recommendation for surgery this figure rose to 47% within 5 years. WebConclusions: Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. sharing sensitive information, make sure youre on a federal 13 general health condition is usually good, so SSO could be an appropriate procedure for adults with TCS. 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.