scholarly journals Vertebral Column Shortening for Recurrent Tethered Cord Syndrome

2022 ◽  
Vol 157 ◽  
pp. 240-241
Author(s):  
Alexander J. Schupper ◽  
Yakov Gologorsky
Keyword(s):  
Vertebral Column ◽  
Tethered Cord ◽  
Tethered Cord Syndrome

Posterior vertebral column subtraction osteotomy: a novel surgical approach for the treatment of multiple recurrences of tethered cord syndrome

2009 ◽  
Vol 10 (4) ◽  
pp. 278-286 ◽  
Author(s):  
Patrick C. Hsieh ◽  
Stephen L. Ondra ◽  
Andrew W. Grande ◽  
Brian A. O'Shaughnessy ◽  
Karin Bierbrauer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Column ◽  
Spinal Column ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
The Novel ◽  
Tethered Spinal Cord ◽  
Vertebral Column Resection ◽  
Csf Leakage ◽  
Multiple Recurrences

Recurrent tethered cord syndrome (TCS) has been reported to develop in 5–50% of patients following initial spinal cord detethering operations. Surgery for multiple recurrences of TCS can be difficult and is associated with significant complications. Using a cadaveric tethered spinal cord model, Grande and colleagues demonstrated that shortening of the vertebral column by performing a 15–25-mm thoracolumbar osteotomy significantly reduced spinal cord, lumbosacral nerve root, and terminal filum tension. Based on this cadaveric study, spinal column shortening by a thoracolumbar subtraction osteotomy may be a viable alternative treatment to traditional surgical detethering for multiple recurrences of TCS. In this article, the authors describe the use of posterior vertebral column subtraction osteotomy (PVCSO) for the treatment of 2 patients with multiple recurrences of TCS. Vertebral column resection osteotomy has been widely used in the surgical correction of fixed spinal deformity. The PVCSO is a novel surgical treatment for multiple recurrences of TCS. In such cases, PVCSO may allow surgeons to avoid neural injury by obviating the need for dissection through previously operated sites and may reduce complications related to CSF leakage. The novel use of PVCSO for recurrent TCS is discussed in this report, including surgical considerations and techniques in performing PVCSO.

scholarly journals Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S107-S107
Author(s):  
Nicholas Theodore ◽  
Ethan Cottrill ◽  
Samuel Kalb ◽  
Corinna Zygourakis ◽  
Bowen Jiang ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Vertebral Column ◽  
Tethered Cord ◽  
Tethered Cord Syndrome

Vertebral column subtraction osteotomy for recurrent tethered cord syndrome in adults: a cadaveric study

2006 ◽  
Vol 4 (6) ◽  
pp. 478-484 ◽  
Author(s):  
Andrew W. Grande ◽  
P. Colby Maher ◽  
Chad J. Morgan ◽  
Ondrej Choutka ◽  
Benjamin C. Ling ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Column ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Thoracolumbar Junction ◽  
Neural Element ◽  
Nerve Roots ◽  
Tension Reduction ◽  
Increased Risk ◽  
Fresh Frozen

Object The standard treatment for lumbosacral tethered cord syndrome (TCS) in adults is surgical detethering. In patients with recurrent TCS, additional detethering operations are associated with increased risk of complications and subsequent scar formation. The authors studied the effect of undertaking a vertebral column subtraction osteotomy (VCSO) at the thoracolumbar junction to shorten the vertebral column and reduce neural element tension. Methods A model of TCS, developed in fresh-frozen human cadavers, was evaluated in three experiments. In Experiment 1, VCSO of 20 to 25 mm was performed at the T11–12 level. The vertebral column was sequentially shortened and the reduction in tension was measured separately in the terminal filum and the L-1 to S-3 or S-4 nerve roots. In Experiments 2 and 3 the reduction in tension was measured in the spinal cord after a VCSO and after simulating a traditional detethering operation. Vertebral column shortening produced tension reduction in all experiments. Tension decreased to less than 0.6 g in the terminal filum, L1–S3/4 nerve roots, and spinal cord after closure of a 20- to 25-mm VCSO. The mean ± standard deviation of the Δtension/Δdistance was −0.242 ± 0.019 g/mm for the terminal filum, −0.246 ± 0.019 g/mm for the lumbar nerve roots, and −0.216 ± 0.040 g/mm for the sacral nerve roots. A simulated traditional detethering operation required significant neural element release (detethering) to achieve spinal cord tension reduction equivalent to VCSO. Conclusions A VCSO significantly reduced neural tension at the thoracolumbar junction. This novel procedure may provide an alternative to traditional surgical detethering when scarring is excessive and the risk of complications and retethering are high.

scholarly journals Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis

Neurosurgery ◽  
2020 ◽  
Author(s):  
Nicholas Theodore ◽  
Ethan Cottrill ◽  
Samuel Kalb ◽  
Corinna Zygourakis ◽  
Bowen Jiang ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Vertebral Column ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Leg Pain ◽  
Column Height ◽  
Definitive Treatment ◽  
Inclusion Criteria ◽  
Safety And Efficacy

Abstract BACKGROUND Few have explored the safety and efficacy of posterior vertebral column subtraction osteotomy (PVCSO) to treat tethered cord syndrome (TCS). OBJECTIVE To evaluate surgical outcomes after PVCSO in adults with TCS caused by lipomyelomeningocele, who had undergone a previous detethering procedure(s) that ultimately failed. METHODS This is a multicenter, retrospective analysis of a prospectively collected cohort. Patients were prospectively enrolled and treated with PVCSO at 2 institutions between January 1, 2011 and December 31, 2018. Inclusion criteria were age ≥18 yr, TCS caused by lipomyelomeningocele, previous detethering surgery, and recurrent symptom progression of less than 2-yr duration. All patients undergoing surgery with a 1-yr minimum follow-up were evaluated. RESULTS A total of 20 patients (mean age: 36 yr; sex: 15F/5M) met inclusion criteria and were evaluated. At follow-up (mean: 23.3 ± 7.4 mo), symptomatic improvement/resolution was seen in 93% of patients with leg pain, 84% in back pain, 80% in sensory abnormalities, 80% in motor deficits, 55% in bowel incontinence, and 50% in urinary incontinence. Oswestry Disability Index improved from a preoperative mean of 57.7 to 36.6 at last follow-up (P < .01). Mean spinal column height reduction was 23.4 ± 2.7 mm. Four complications occurred: intraoperative durotomy (no reoperation), wound infection, instrumentation failure requiring revision, and new sensory abnormality. CONCLUSION This is the largest study to date assessing the safety and efficacy of PVCSO in adults with TCS caused by lipomyelomeningocele and prior failed detethering. We found PVCSO to be an excellent extradural approach that may afford definitive treatment in this particularly challenging population.

Management of recurrent adult tethered cord syndrome

2010 ◽  
Vol 29 (1) ◽  
pp. E5 ◽  
Author(s):  
Patrick Shih ◽  
Ryan J. Halpin ◽  
Aruna Ganju ◽  
John C. Liu ◽  
Tyler R. Koski
Keyword(s):  
Vertebral Column ◽  
Adult Population ◽  
Tethered Cord ◽  
Clinical Suspicion ◽  
Tethered Cord Syndrome ◽  
Dural Closure ◽  
Multidisciplinary Clinic ◽  
Inadequate Care ◽  
High Degree

Recurrent tethered cord syndrome (TCS) can lead to significant progressive disability in adults. The diagnosis of TCS is made with a high degree of clinical suspicion. In the adult population, many patients receive inadequate care unless they are seen at a multidisciplinary clinic. Successful detethering procedures require careful intradural dissection and meticulous wound and dural closure. With multiple revision procedures, vertebral column shortening has become an appropriate alternative to surgical detethering.

scholarly journals Posterior vertebral column subtraction osteotomy for the treatment of tethered cord syndrome: review of the literature and clinical outcomes of all cases reported to date

2010 ◽  
Vol 29 (1) ◽  
pp. E6 ◽  
Author(s):  
Patrick C. Hsieh ◽  
Christopher J. Stapleton ◽  
Pavel Moldavskiy ◽  
Tyler R. Koski ◽  
Stephen L. Ondra ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Column ◽  
Spinal Column ◽  
Tethered Cord ◽  
Original Description ◽  
Tethered Cord Syndrome ◽  
Initial Release ◽  
Single Posterior Approach ◽  
Cadaveric Model

Tethered cord syndrome (TCS) is a debilitating condition of progressive neurological decline caused by pathological, longitudinal traction on the spinal cord. Surgical detethering of the involved neural structures is the classic method of treatment for lumbosacral TCS, although symptomatic retethering has been reported in 5%–50% of patients following initial release. Subsequent operations in patients with complex lumbosacral dysraphic lesions are fraught with difficulty, and improvements in neurological function are modest while the risk of complications is high. In 1995, Kokubun described an alternative spine-shortening procedure for the management of TCS. Conducted via a single posterior approach, the operation relies on spinal column shortening to relieve indirectly the tension placed on the tethered neural elements. In a cadaveric model of TCS, Grande and colleagues further demonstrated that a 15–25-mm thoracolumbar subtraction osteotomy effectively reduces spinal cord, lumbosacral nerve root, and filum terminale tension. Despite its theoretical appeal, only 18 reports of the use of posterior vertebral column subtraction osteotomy for TCS treatment have been published since its original description. In this review, the authors analyze the relevant clinical characteristics, operative data, and postoperative outcomes of all 18 reported cases and review the role of posterior vertebral column subtraction osteotomy in the surgical management of primary and recurrent TCS.

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