Microsurgical repair of lumbar Segmental Myelocystocele and spinal cord Untethering: 2-Dimensional operative video

Lumbar (non-terminal) myelocystocele is a rare form of closed spinal dysraphism which is characterized by posterior bony defect [1-3], a herniated segment of the spinal cord associated with cystic dilatation of the central canal [1-3], and surrounded by cyst filled with CSF in the subarachnoid space i.e. cyst-within-a-cyst. [1-4] The mass is covered by intact skin and variable amounts of subcutaneous fat which is often attached to neural tissue. [1-3] Surgery is advocated to untether the cord and reconstruct the neural tube which will prevent further neurological deterioration. [1-3] In this video, we present the case of a 7-month-old boy who was presented with skin skin-covered lumbar mass after birth. He had left foot drop with no movement in the toes and right foot inversion with associated weakness in the toes. There were no developmental delays and he did not have anorectal anomalies. Magnetic Resonance Imaging (MRI) spine confirmed the diagnosis of lumbar myelocystocele, and urinary flow studies showed good bladder capacity with reasonable voids. The patient underwent spinal cord untethering, neurulation of the neural placode, and duraplasty with an artificial dural graft to increase the cord-sac ratio. [5-7] Postoperative motor power was similar to baseline. The urinary catheter was removed three weeks after surgery with adequate voiding. The were no concerns related to the wound. The parents consented to the procedure and the publication of the patient's video. Institutional Review Board approval was not required.