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A novel minimally invasive technique for spinal cord untethering
Trent L Tredway1, Wael Musleh, Sean D Christie
1Section of Neurosurgery, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
Neurosurgery
|February 14, 2007
Summary
Minimally invasive surgery effectively treats tethered spinal cords by sectioning the filum terminale. This approach offers reduced pain, smaller incisions, and faster recovery for patients with spinal cord tension.
Area of Science:
- Neurosurgery
- Minimally Invasive Spine Surgery
- Spinal Cord Pathology
Background:
- Tethered cord syndrome results from abnormal spinal cord fixation, causing tension, ischemia, and symptoms like incontinence, scoliosis, and pain.
- Sectioning the filum terminale can alleviate symptoms in cases of fatty or tight filum terminale.
- Minimally invasive surgical techniques offer potential advantages over traditional open surgery for spinal conditions.
Observation:
- Three patients (14, 35, 46 years) with chronic leg/back pain, scoliosis, and/or incontinence presented with tethered cord syndrome and thickened, fatty filum terminale.
- Neuroradiological findings confirmed tethered cord syndrome in all patients.
- One patient exhibited abnormal urodynamic studies indicative of sphincter dysfunction.
Findings:
- A novel minimally invasive technique using an X-tube system was employed for spinal cord untethering at the L4/L5 level.
- Intradural microdissection allowed identification and sectioning of the fatty filum terminale, confirmed by electromyographic monitoring.
- All patients experienced significant improvement in leg and back pain, with one showing resolution of urodynamic abnormalities.
Implications:
- Minimally invasive surgery provides a safe and effective method for untethering spinal cords.
- This technique minimizes soft tissue injury, postoperative pain, blood loss, and hospitalization duration.
- Reduced tissue trauma may decrease scar formation and the risk of spinal cord retethering.
