Adult-onset tethered cord syndrome with a retained medullary cord due to adhesive arachnoiditis

Background

Adult-onset tethered cord syndrome (ATCS) is occasionally reported, but older adult onset is very rare. We treated a patient who was asymptomatic until older adulthood and then developed subacute exacerbation of neurological symptoms.

Case description

A 76-year-old woman presented with bilateral leg pain, numbness, and weakness plus low back pain and dysuria for 1 month. Imaging showed a retained medullary cord with a syrinx and an enhanced mass lesion. She was diagnosed with symptomatic ATCS and underwent surgery. Intraoperative findings were an intramedullary syrinx and inflammatory granulation due to adhesive arachnoiditis.

Conclusion

We experienced a very rare case in which an older adult developed ATCS. Caution is required because idiopathic adhesive arachnoiditis can exacerbate the neurological symptoms.