Tandem Detethering: A Novel One-Stage Approach Combining Cervicothoracic Cord Release Followed by Filum Terminale...

Area of Science:

• Neurosurgery
• Spinal Surgery
• Neurology

Background:

• Patients with symptomatic cervicothoracic spinal cord tethering often have underlying congenital or acquired spinal pathologies.
• Incidental findings of low-lying conus or abnormal filum terminale (FT) suggest potential concomitant conus tethering contributing to symptoms.

Purpose of the Study:

• To evaluate the efficacy of single-stage "tandem detethering" in patients with symptomatic cervicothoracic spinal cord tethering and concurrent FT abnormalities.
• To assess the impact of addressing both cervicothoracic and filum terminale tethering on neurological recovery.

Main Methods:

• Prospective review of five patients undergoing microsurgical release of cervicothoracic pathology followed by FT resection.
• Preoperative assessment included clinical presentation, imaging (MRI), and intraoperative findings.
• Outcomes were evaluated at six months, focusing on motor, sensory, pain, and autonomic function.

Main Results:

• All five patients had a history of prior spinal interventions causing cervicothoracic tethering.
• Preoperative MRI revealed low-lying conus in two patients and abnormal FT in four patients.
• All patients showed improvement in motor, sensory, pain, and urinary/bowel symptoms at six months post-surgery.
• Complications included two pseudomeningoceles and one instance of recurrent cauda tethering.

Conclusions:

• Concomitant low-lying conus or pathological FT can perpetuate biomechanical stress in cervicothoracic tethering, potentially limiting neurological recovery.
• Tandem detethering, addressing both cervicothoracic and filum terminale tethering, is a viable surgical strategy for improving outcomes in complex spinal cord tethering cases.
• Surgical release of both pathologies may be necessary for optimal neurological recovery in select patients.