Minimally invasive endoscopic spinal cord untethering: case report

Tethered cord syndrome is a constellation of symptoms and signs that include back and leg pain, bowel and bladder dysfunction, scoliosis and lower extremity weakness and deformity. Tethering may be due to a tight filum terminale or a form of spinal dysraphism. The authors present a case of a 40-year-old man who presented with symptoms of back pain, bilateral lower extremity radicular pain, and bowel and bladder dysfunction. Magnetic resonance imaging showed a sacral lipomyelomeningocele, with fat tracking superiorly to the conus, which was tethered at the L4-L5 level. A minimally-invasive surgical approach with endoscopic visualization and identification of the nerve roots and filum terminale was performed. The patient's postoperative clinical course was uneventful. This case highlights two important issues. First, minimally invasive spine techniques should be considered in the surgical treatment of tethered cord especially given the theoretical advantages of minimizing pain, spinal fluid leakage, and subsequent scarring. And second, endoscopic techniques are advancing. In the case presented here, endoscopic visualization and operative techniques made identification and transection of the filum terminale possible through a tiny dural opening. The small dural opening could theoretically pose the advantage of decreasing the risk of spinal fluid leakage. Clinicians should be aware that endoscopic visualization and techniques can serve as minimally-invasive adjuncts to enhance the traditional approach to many surgical pathologies.