[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-455414-105":59,"doc-detail-455414-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","occult-tethered-cord-syndrome-clinical-characteristics-diagnostic-challenges-and-management-considerations","Occult Tethered Cord Syndrome - Clinical Characteristics, Diagnostic Challenges, and Management Considerations","","Occult tethered cord syndrome (OTCS) presents with clinical features of tethered cord dysfunction despite normal spinal imaging and lacks consensus regarding surgical indications or evaluation criteria. This report describes three surgically treated cases and a narrative literature review addressing epidemiology, pathophysiology, clinical manifestations, diagnostic tools, and surgical versus conservative management, emphasizing pediatric patients. From 2010–2025, all patients showed urologic abnormalities; two improved (66%), while orthopedic deficits largely persisted, with no perioperative complications.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/occult-tethered-cord-syndrome-clinical-characteristics-diagnostic-challenges-and-management-considerations/455414/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/occult-tethered-cord-syndrome-clinical-characteristics-diagnostic-challenges-and-management-considerations/455414.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is occult tethered cord syndrome (OTCS)?","Question",{"text":113,"@type":114},"OTCS is defined as tethered cord clinical manifestations without radiographic evidence of a low-lying conus. In OTCS, neurological deficits can occur despite normal spinal imaging findings.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What diagnostic issues make OTCS controversial?",{"text":118,"@type":114},"There is no consensus on surgical indications or standardized evaluation criteria. Diagnosis relies heavily on clinical judgment and functional testing such as urodynamic studies because imaging can be negative.",{"name":120,"@type":111,"acceptedAnswer":121},"What were the outcomes after surgical treatment in the described cases?",{"text":122,"@type":114},"All three patients had urological abnormalities, and two showed improvement in urological symptoms (66%). Orthopedic abnormalities did not show improvement, and no perioperative complications were observed.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},455414,1790811745,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":46,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Review began 11/24/2025  \nReview ended 12/03/2025  \nPublished 12/08/2025  \n© Copyright 2025  \nKurimoto. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98747  \nOpen Access Case Report  \nOccult Tethered Cord Syndrome: Clinical Characteristics, Diagnostic Challenges, and Management Considerations  \nMichihiro Kurimoto 1  \n1. Pediatric Neurosurgery, Aichi Children 's Health and Medical Center, Ōbu, JPN Corresponding author: Michihiro Kurimoto, [rythmista@me.com](rythmista@me.com)  \nAbstract  \nOccult tethered cord syndrome (OTCS) is defined as the clinical manifestation of a tethered cord without radiographic evidence of a low-lying conus; however, there is no consensus on surgical indications or evaluation criteria. We present three cases treated surgically at our hospital, and in contrast to that, a narrative review of the literature on OTCS was conducted, focusing on epidemiology, pathophysiology, clinical features, diagnostic tools, and surgical versus conservative management. Emphasis was placed on pediatric populations, in whom the syndrome is most frequently described.  \nBetween April 2010 and June 2025, three patients with OTCS underwent surgical sectioning of the filum terminale at our institution. All patients presented with urological abnormalities, and one patient also demonstrated orthopedic involvement. Improvement in urological symptoms was observed in two patients (66%), including resolution of vesicoureteral reflux and nocturnal enuresis, whereas no improvement was noted in orthopedic abnormalities. No perioperative complications were observed. During the follow-up period (median (interquartile range) = 1281 (1264-1490) days), these results indicated that while urinary symptoms after surgical dislocation were highly likely to recover, orthopedic symptoms remained largely refractory in the majority of cases. OTCS remains controversial and heterogeneous. Diagnosis depends largely on clinical judgment, and treatment decisions must balance the potential surgical benefits with the risks and uncertain long-term outcomes. Prospective controlled studies and the development of objective biomarkers are essential for establishing standardized diagnostic and therapeutic guidelines.  \nCategories: Urology, Neurosurgery, Pediatrics  \nKeywords: filum terminale, occult tethered cord syndrome, pediatric neurosurgery, spinal dysraphism, surgical outcomes, urodynamics  \nIntroduction  \nOccult tethered cord syndrome (OTCS) is defined as a condition in which patients present with symptoms such as urinary dysfunction or lower-extremity motor abnormalities, despite normal findings on spinal imaging, including magnetic resonance imaging (MRI) . Common radiological abnormalities associated with classic tethered cord syndrome (TCS) include spinal lipomas, a low-lying conus medullaris, and a thickened filum terminale; however, OTCS represents a rare entity in which neurological deficits occur in the absence of these abnormalities. Problems associated with OTCS include an uncertain pathological basis, and there are no overt imaging findings; surgical indications must rely on clinical symptoms and functional testing (e.g., urodynamic studies), for which no standardized evaluation criteria exist. Although symptom improvement after surgery has been reported, outcomes such as improvement and recurrence rates vary widely across studies, and the therapeutic efficacy remains uncertain. Here, we review pediatric OTCS cases treated at our institution and discuss the diagnostic and therapeutic considerations, considering the literature.  \nThe conceptual origin of OTCS can be traced to the mid-20th century, when the broad clinical recognition of TCS emerged. Hoffman et al. clarified the clinical features of TCS associated with spina b","cbCaivOMbKYmFkpz","https://ap.wps.com/l/cbCaivOMbKYmFkpz","pdf",2285695,"English","# Abstract\n# Introduction\n# Case Presentation\n## Case 1\n# How to cite this article","[{\"question\":\"What is occult tethered cord syndrome (OTCS)?\",\"answer\":\"OTCS is defined as tethered cord clinical manifestations without radiographic evidence of a low-lying conus. In OTCS, neurological deficits can occur despite normal spinal imaging findings.\"},{\"question\":\"What diagnostic issues make OTCS controversial?\",\"answer\":\"There is no consensus on surgical indications or standardized evaluation criteria. Diagnosis relies heavily on clinical judgment and functional testing such as urodynamic studies because imaging can be negative.\"},{\"question\":\"What were the outcomes after surgical treatment in the described cases?\",\"answer\":\"All three patients had urological abnormalities, and two showed improvement in urological symptoms (66%). Orthopedic abnormalities did not show improvement, and no perioperative complications were observed.\"}]","Occult Tethered Cord Syndrome - Clinical Characteristics, Diagnostic Challenges, and Management Considerations | PDF",1790742817]