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Concurrent spinal cord untethering and scoliosis correction: case report
Amer F Samdani1, JahanGir Asghar, Joshua Pahys
1Shriners Hospital for Children, Philadelphia, Pennsylvania 19140, USA. amersamdani@yahoo.com
Spine
|December 20, 2007
Summary
This case report demonstrates that concurrent spinal cord untethering and scoliosis correction is a safe and effective surgical option. This combined approach successfully resolved neurological symptoms in a patient with progressive kyphoscoliosis.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Pediatric Spine Surgery
Background:
- Congenital and infantile scoliosis can present with a high incidence (up to 20%) of intraspinal anomalies.
- These anomalies, including tethered cord syndrome, often require intervention before scoliosis correction to prevent neurological complications.
Observation:
- A 15-year-old male with progressive kyphoscoliosis (65° thoracic, 80° lumbar) and neurological deficits (lower extremity paresthesias, urinary incontinence) was evaluated.
- Preoperative MRI revealed a low-lying conus medullaris at L4, indicating a tethered spinal cord.
Findings:
- The patient underwent successful concurrent untethering of the filum terminale and posterior spinal fusion (T2 to pelvis) with comprehensive intraoperative neuromonitoring.
- Postoperatively, the patient ambulated on day 2, with complete resolution of paresthesias and improvement in urinary symptoms, maintaining good condition at 9 months.
Implications:
- Concurrent spinal cord untethering and scoliosis correction is a viable alternative to staged procedures for select patients.
- This combined surgical approach offers potential benefits in managing complex spinal deformities with associated intraspinal anomalies.