Surgical Neurology International

Tools

Spinal cord detethering without laminectomy or laminotomy

Category:

Article Type:

Steven B. Housley¹, Devan Patel², Elizabeth Nyabuto¹, Renée M. Reynolds^1,3

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States.
College of Medicine, Florida State University, Tallahassee, Florida, United States.
Department of Neurosurgery, John R. Oishei Children’s Hospital, Buffalo, New York, United States.

Correspondence Address:
Renée M. Reynolds, Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, United States.

DOI:10.25259/SNI_942_2021

Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Steven B. Housley1, Devan Patel2, Elizabeth Nyabuto1, Renée M. Reynolds1,3. Spinal cord detethering without laminectomy or laminotomy. 14-Dec-2021;12:610

How to cite this URL: Steven B. Housley1, Devan Patel2, Elizabeth Nyabuto1, Renée M. Reynolds1,3. Spinal cord detethering without laminectomy or laminotomy. 14-Dec-2021;12:610. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11290

Date of Submission
18-Sep-2021

Date of Acceptance
09-Nov-2021

Date of Web Publication
14-Dec-2021

Abstract

Background: Tethered cord syndrome occurs when there is abnormal tension on the distal spinal cord, which limits its elevation as patients grow. This results in stretching of the neural elements and microvasculature, resulting in both direct and ischemic injury.[7] Animal studies suggest that impairment of oxidative metabolic pathways may contribute to neuronal injury.[7] Associated conditions include myelomeningocele, lipomyelomeningocele, intraspinal lipomas, diastematomyelia, thickened/fatty filum terminale, and trauma.[2] Tethering may be asymptomatic or result in a variety of symptoms including lower extremity weakness/sensory deficits, bowel/bladder dysfunction, scoliosis, pes cavus, and back/leg pain.[6] Early surgical intervention has been shown to improve outcomes and may be performed prophylactically or to prevent symptom progression.[1,3] More specifically, retrospective studies demonstrate that surgical intervention in patients under the age of 2 years is associated with improved outcomes.[5] In some cases, detethering may result in clinical improvement.[3]

Case Description: We present a case of a 6-month-old male with a low-lying conus medullaris, lumbar syrinx, mildly abnormal urodynamic studies, and asymmetric utilization of his lower extremities observed during the evaluation of a Y-shaped gluteal cleft. He underwent elective spinal cord detethering via the safe and effective, minimally invasive technique described in the video.

Conclusion: Given the variety of surgical techniques used for cord detethering, this video may assist other surgeons in developing techniques that require little to no compromise of the developing bony spinal column while achieving sufficient release of the spinal cord.[4]

Keywords: Detethering, Filum terminale, Pediatric, Tethered cord

Video 1

Annotations[1-7]

0:20 – Presentation magnetic resonance image

1:54 – Opening of ligamentum flavum

2:24 – Opening of dura

2:34 – Isolation of the filum terminale

2:53 – Cutting of the filum terminale

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

[Video 1]-Available on

https://doi.org/10.25259/SNI_942_2021

References

1. Alsowayan O, Alzahrani A, Farmer JP, Capolicchio JP, Jednak R, El-Sherbiny M. Comprehensive analysis of the clinical and urodynamic outcomes of primary tethered spinal cord before and after spinal cord untethering. J Pediatr Urol. 2016. 12: 285.e1-5

2. Hertzler DA, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: A review of the literature from embryology to adult presentation. Neurosurg Focus. 2010. 29: E1

3. Lew SM, Kothbauer KF. Tethered cord syndrome: an updated review. Pediatr Neurosurg. 2007. 43: 236-48

4. Solmaz I, Izci Y, Albayrak B, Cetinalp E, Kural C, Sengul G. Tethered cord syndrome in childhood: Special emphasis on the surgical technique and review of the literature with our experience. Turk Neurosurg. 2011. 21: 516-21

5. Tseng JH, Kuo MF, Kwang Tu Y, Tseng MY. Outcome of untethering for symptomatic spina bifida occulta with lumbosacral spinal cord tethering in 31 patients: Analysis of preoperative prognostic factors. Spine J. 2008. 8: 630-8

6. Yamada S, Won DJ, Siddiqi J, Yamada SM. Tethered cord syndrome: Overview of diagnosis and treatment. Neurol Res. 2004. 26: 719-21

7. Yamada S, Won DJ, Yamada SM. Pathophysiology of tethered cord syndrome: Correlation with symptomatology. Neurosurg Focus. 2004. 16: E6