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This article, published in the Journal of Medical Case Reports, discusses a surgical technique for treating tethered cord syndrome. The authors describe the case of a 47-year-old woman with symptoms of leg numbness and urinary dysfunction. Magnetic resonance imaging revealed a low-lying conus medullaris, and the diagnosis was adult tethered cord syndrome. The surgical procedure involved spine-shortening vertebral osteotomy at the L2 level. The authors provide detailed instructions for the surgical technique, which includes the use of pedicle screw implants, resection of the lamina, and removal of the vertebral body. The results of this procedure demonstrated successful reduction of spinal cord tension without causing neural damage. The authors argue that this technique can be a viable treatment option for patients with tethered cord syndrome
Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article
: Spine-shortening osteotomy that preserves the caudal one-third of the pedicle and lamina with one-above and one-below instrumentation successfully reduced the spinal cord tension without causing neural damage.
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J Med Case Rep. 2023 Oct 11;17(1):425. doi: 10.1186/s13256-023-04155-x.ABSTRACTBACKGROUND: Miyakoshi et al. reported three cases of tethered cord syndrome treated by spine-shortening vertebral osteotomy, which provided relief of the patients’ symptoms with no complications. Although the details of these cases were described in a previous report, the surgical technique was not thoroughly explained. In the,
J Med Case Rep. 2023 Oct 11;17(1):425. doi: 10.1186/s13256-023-04155-x.
ABSTRACT
BACKGROUND: Miyakoshi et al. reported three cases of tethered cord syndrome treated by spine-shortening vertebral osteotomy, which provided relief of the patients’ symptoms with no complications. Although the details of these cases were described in a previous report, the surgical technique was not thoroughly explained. In the present report, we describe the details of our procedure with reference to a fourth case.
CASE PRESENTATION: A 47-year-old Asian woman was admitted to our hospital with a 1-year history of worsening leg numbness and urinary dysfunction. Magnetic resonance imaging revealed a low-lying conus medullaris extending to the level of S2 and surrounded by fat tissue at that level. We diagnosed her condition as adult tethered cord syndrome, and spine-shortening vertebral osteotomy was planned. The target level for the osteotomy was L2. Bilateral pedicle screw implants were placed at L1 and L3 using an anterior-posterior image intensifier. In this procedure, it is essential to use monoaxial screws inserted exactly parallel to the rostral endplates of each vertebral body; this ensures appropriate alignment between the L1 caudal endplate and the L2 osteotomy surface. The upper one-third of the lamina of L2 was resected, and the bilateral two-thirds of the pedicle of L2 was removed with a surgical air drill. After exposure of the lateral side of the L1-2 disc, discectomy was performed with a knife and curette. Following complete discectomy of L1-2, the upper vertebral body of L2 was removed with a surgical air drill. After complete removal of the vertebral body, a straight rod was connected to two screws and applied pressure between the screws. Two polyethylene tapes were applied to the L2 lamina and bilateral rods.
: Spine-shortening osteotomy that preserves the caudal one-third of the pedicle and lamina with one-above and one-below instrumentation successfully reduced the spinal cord tension without causing neural damage.
PMID:37817238 | PMC:PMC10566082 | DOI:10.1186/s13256-023-04155-x
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Read the original publication:
Surgical technique of spine-shortening vertebral osteotomy for adult tethered cord syndrome: a case report and review of the literature
