Tethered Twine as a Complication of Persistent Cerebral Spinal Fluid Diversion.

Int J Backbone Surg. 2017;11:26

Authors: Agarwal N, Hansberry DR, Goldstein IM

Summary
Introduction: The etiology and therapy of tethered twine syndrome stays controversial, particularly in adults. We current an uncommon case of tethered twine syndrome with an related epidural lipomatosis probably as a consequence of continual over shunting of cerebrospinal fluid (CSF).
Strategies: A 25-year-old girl had a historical past of Chiari malformation, hydrocephalus, and a ventriculoperitoneal shunt. She demonstrated progressively worsening gait, which led to a analysis of myelopathy and a posterior cervical decompression and fusion was carried out. Imaging revealed engorgement of the epidural veins ventral to the spinal twine which was inflicting twine compression. Magnetic resonance (MR) imaging of the lumbar backbone demonstrated a low-lying conus on the degree of L2-L3 with an absence of CSF within the lumbar cistern. This was related to this was a widening of the epidural area with secondary epidural lipomatosis. She underwent a laminectomy of L5 in addition to decompression of the inferior side of the L4 and superior side of the S1 lamina. No free stream of CSF might ever be appreciated as was urged by postoperative MR imaging. Postoperatively, the affected person did nicely and was discharged in steady situation.
Conclusion: Tethering of the spinal twine, related to epidural lipomatosis, could also be secondary to over-drainage of CSF. Signs of again ache and tethered twine phenomenon might warrant surgical intervention.

PMID: 29372130 [PubMed]