346 The Utility of Posterior Vertebral Column Subtraction Osteotomies for Tethered Cord Syndrome

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 278-278
Author(s):  
Shashank V Gandhi ◽  
Ahmad Latefi
Keyword(s):  
Spinal Cord ◽  
Preoperative Evaluation ◽  
Spinal Column ◽  
Tethered Cord ◽  
Radicular Pain ◽  
Neurological Injury ◽  
Csf Leak ◽  
Wound Breakdown ◽  
Spinal Cord Herniation ◽  
Pain Symptoms

Abstract INTRODUCTION Detethering of the spinal cord has historically been the treatment of choice for TCS in the setting of spinal dysraphisms. Recurrent TCS occurs 5–80% of patients. Risk of neurological injury, CSF leak, and wound breakdown increase with subsequent procedures. Kokubun et al. described using PVCSO without microsurgical detethering to relieve stretch strain on the spinal cord; however, there is a paucity of literature on its success. Here we describe our experience with PVCSO for TCS. METHODS A prospectively collected database patients with TCS who underwent PVCSO or were being monitored for potential surgery was analyzed. A team of two neurosurgeons evaluated each patient for potential benefit from spinal shortening osteotomies. Preoperative evaluation included MRI and upright radiographs to assess for location and type of tethering and presence of deformity. Single stage posterior PVCSO were conducted at a neutral level rostral to the tethering site, shortening by 10–15mm. When present PVCSOs were concurrently utilized to correct deformities. RESULTS >6 patients were assessed. 4 patients had failed previous microsurgical detethering at least once. 4 patients underwent PVCSO due to worsening of symptoms: 2 with history of myelomeningocele repair and 2 with arachnoid adhesions after spinal subdural hematoma. All 4 had resolution of weakness, numbness, and radicular pain of legs. Incontinence improved in the patient with arachnoid adhesions. There was no worsening of neurological function. 1 patient with spinal cord herniation and scoliosis, had improved radiculopathy from detethering. CONCLUSION In this series all patients who underwent PVCSO for TCS experiences improvement in motor, sensory, and pain symptoms. Indirect relief of in-line strain and stretch on the spinal cord is possible through PVCSO by shortening the spinal column, without high risk of recurrence of symptoms or neurological injury as there is no direct manipulation of neural elements. PVCSO can be utilized for both congenital and acquired TCS.

scholarly journals Spinal column shortening for tethered cord syndrome associated with myelomeningocele, lumbosacral lipoma, and lipomyelomeningocele in children and young adults

2017 ◽  
Vol 19 (6) ◽  
pp. 703-710 ◽  
Author(s):  
Guillermo Aldave ◽  
Daniel Hansen ◽  
Steven W. Hwang ◽  
Amee Moreno ◽  
Valentina Briceño ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Young Adults ◽  
Spinal Column ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Neurological Deficits ◽  
Csf Leak ◽  
Cord Injury ◽  
Children And Young Adults

OBJECTIVETethered cord syndrome is the clinical manifestation of an abnormal stretch on the spinal cord, presumably causing mechanical injury, a compromised blood supply, and altered spinal cord metabolism. Tethered cord release is the standard treatment for tethered cord syndrome. However, direct untethering of the spinal cord carries potential risks, such as new neurological deficits from spinal cord injury, a CSF leak from opening the dura, and retethering of the spinal cord from normal scar formation after surgery. To avoid these risks, the authors applied spinal column shortening to children and transitional adults with primary and secondary tethered cord syndrome and report treatment outcomes. The authors' aim with this study was to determine the safety and efficacy of spinal column shortening for tethered cord syndrome by analyzing their experience with this surgical technique.METHODSThe authors retrospectively reviewed the demographic and procedural data of children and young adults who had undergone spinal column shortening for primary or secondary tethered cord syndrome.RESULTSSeven patients with tethered cord syndrome caused by myelomeningocele, lipomyelomeningocele, and transitional spinal lipoma were treated with spinal column shortening. One patient with less than 24 months of follow-up was excluded from further analysis. There were 3 males and 4 females; the average age at the time was surgery was 16 years (range 8–30 years). Clinical presentations for our patients included pain (in 5 patients), weakness (in 4 patients), and bowel/bladder dysfunction (in 4 patients). Spinal column osteotomy was most commonly performed at the L-1 level, with fusion between T-12 and L-2 using a pedicle screw-rod construct. Pedicle subtraction osteotomy was performed in 6 patients, and vertebral column resection was performed in 1 patient. The average follow-up period was 31 months (range 26–37 months). Computed tomography–based radiographic outcomes showed solid fusion and no instrumentation failure in all cases by the most recent follow-up. Five of 7 patients (71%) reported improvement in preoperative symptoms during the follow-up period. The mean differences in initial and most recent Scoliosis Research Society Outcomes Questionnaire and Oswestry Disability Index scores were 0.26 and –13%, respectively; minimum clinically important difference in SRS-22 and ODI were assumed to be 0.4% and –12.8%, respectively.CONCLUSIONSSpinal column shortening seems to represent a safe and efficacious alternative to traditional untethering of the spinal cord for tethered cord syndrome.

Spinal Column Shortening for Secondary Tethered Cord Syndrome in Children: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (6) ◽  
pp. E168-E168
Author(s):  
Jacob Archer ◽  
Andrew Jea
Keyword(s):  
Spinal Cord ◽  
Spinal Column ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Motor Dysfunction ◽  
Bladder Function ◽  
Neurological Injury ◽  
Leg Length ◽  
Renal Anomalies ◽  
Advantages And Disadvantages

Abstract Tethered cord syndrome is a constellation of signs and symptoms involving sensory and motor dysfunction of the lower extremities, bladder, and bowel. The pathophysiology may be from a mechanical stretch of the distal spinal cord causing deleterious changes in blood supply and metabolism. The standard of care for tethered cord syndrome has been tethered cord release. However, drawbacks of traditional tethered cord release include neurological injury, cerebrospinal fluid leak, and intradural scarring and retethering of the spinal cord (secondary tethering). As such, spinal column shortening was described to avoid these risks.1 We applied spinal column shortening to children and transitional adults with secondary tethered cord syndrome.1 As shown in cadaveric biomechanical studies, the objective of surgery is to shorten by the spinal column by 1.5 to 2.5 cm, to obtain the equivalent relief of traction on the spinal cord and nerve roots as direct circumferential untethering.2 In this video, we present the case of an 11-yr-old boy with a history of VATERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) and tethered cord syndromes manifest as bladder dysfunction. Our patient had segmentation and formation anomalies of the lumbosacral junction, imperforate anus, and leg length discrepancy. He had already undergone multiple tethered cord releases with no durable improvement in bladder function. After discussion of the advantages and disadvantages of spinal column shortening with the patient and his father, we decided to proceed with this treatment alternative. At 9 mo after surgery, the patient has satisfactory clinical and radiographic outcomes. Informed consent was obtained from the parents of the patient.

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 Spinal column shortening versus revision detethering for recurrent adult tethered cord syndrome: a preliminary comparison of perioperative and clinical outcomes

2020 ◽  
Vol 32 (6) ◽  
pp. 958-964
Author(s):  
Can Zhang ◽  
Chih-Chang Chang ◽  
Praveen V. Mummaneni ◽  
Chenghua Yuan ◽  
Sanjay Dhall ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Blood Loss ◽  
Lower Extremity ◽  
Clinical Outcomes ◽  
Spinal Column ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Bladder Function ◽  
Perioperative Outcomes ◽  
Estimated Blood Loss

OBJECTIVERecurrent tethered cord syndrome (TCS), believed to result from tension on the distal portion of the spinal cord, causes a constellation of neurological symptoms. Detethering surgery has been the traditional treatment for TCS. However, in cases of recurrent TCS, there is a risk of new neurological deficits developing, and subsequent retethering is difficult to prevent. Spinal column shortening has been proposed as an alternative technique to reduce the tension on the spinal cord without incurring the morbidity of revision surgery on the spinal cord. The authors compared the perioperative outcomes and morbidity of patients who were treated with one or the other procedure.METHODSThe medical records of 16 adult patients with recurrent TCS who were treated between 2005 and 2018 were reviewed. Eight patients underwent spinal column shortening, and 8 patients underwent revision detethering surgery. Patient demographics, clinical outcomes, and perioperative factors were analyzed. The authors include a video to illustrate their technique of spinal column shortening.RESULTSWithin the spinal column shortening group, no patients experienced any complications, and all 8 patients either improved or stabilized with regard to lower-extremity and bowel and bladder function. Within the revision detethering group, 2 patients had worsening of lower-extremity strength, 3 patients had worsening of bowel and bladder function, and 1 patient had improvement in bladder function. Also, 3 patients had wound-related complications. The median estimated blood loss was 731 ml in the shortening group and 163 ml in the revision detethering group. The median operative time was 358 minutes in the shortening group and 226 minutes in the revision detethering group.CONCLUSIONSClinical outcomes were comparable between the groups, but none of the spinal column shortening patients experienced worsening, whereas 3 of the revision detethering patients did and also had wound-related complications. Although the operative times and blood loss were higher in the spinal column shortening group, this procedure may be an alternative to revision detethering in extremely scarred or complex wound revision cases.

Regional injuries of the cervical spine: sports-related anatomical, pathophysiological, and clinical perspectives

2013 ◽  
Author(s):  
Ezequiel Gherscovici ◽  
Eli Baron ◽  
Alexander Vaccaro
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Motor Vehicle ◽  
Spinal Column ◽  
Neurological Injury ◽  
Spine Injury ◽  
Sporting Events ◽  
Cervical Spine Injuries ◽  
Cord Injury ◽  
Athletic Field

Cervical spine injuries occur infrequently on the athletic field (Dietz and Lillegard 1999). Nevertheless, sporting events have been reported as the fourth most common cause of spinal cord injury (behind motor vehicle collisions, assaults, and falls) (NSCISC 2006). The possibility of catastrophic cervical spine injury exists with involvement in sports, where it can be defined as ‘structural distortion of the cervical spinal column associated with actual or potential damage to the spinal cord’. This may result in irreversible neurological injury to the athlete (...

Partial Costotransversectomy and Corpectomy for Thoracic Spinal Metastatic Disease: Operative Technique and Nuances: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (3) ◽  
pp. E101-E101
Author(s):  
Oluwaseun O Akinduro ◽  
Eric W Nottmeier
Keyword(s):  
Spinal Cord ◽  
Metastatic Disease ◽  
Spinal Metastasis ◽  
Preoperative Evaluation ◽  
Transverse Process ◽  
Radicular Pain ◽  
Medial Aspect ◽  
Lower Back ◽  
Thoracic Spinal ◽  
Postoperative Improvement

Abstract We describe the operative approach and management for thoracic metastatic disease in a 78-yr-old man with worsening mechanical lower back and left-sided thoracic radicular pain. Imaging of the thoracic spine revealed an osteolytic T11 mass with destruction of the left T11 pedicle and transverse process. Biopsy confirmed spinal metastasis from the liver. Preoperative angiogram was completed for localization of the artery of Adamkewicz and microparticle embolization of the left T11 intercostal artery. Surgical resection was supplemented with electrophysiological monitoring and neuronavigation. The corpectomy was approached by resecting the medial aspect of the rib, transverse process, and pedicle, which were all invaded with tumor. The left T11 nerve root was isolated and sacrificed to allow for placement of the expandable corpectomy cage and also resulted in sustained relief of the patient's radicular pain. The patient recovered from surgery well, with postoperative improvement of his pain. This case highlights the complex technical nuances of this procedure, and the importance of a thorough preoperative evaluation, including angiography, as proper identification of the artery of Adamkewitz can prevent severe neurological deficit from a spinal cord stroke. The patient consented to the procedure.

scholarly journals Pathophysiology of tethered cord syndrome: correlation with symptomatology

2004 ◽  
Vol 16 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Shokei Yamada ◽  
Daniel J. Won ◽  
Shoko M. Yamada
Keyword(s):  
Spinal Cord ◽  
Spinal Column ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Functional Disorder ◽  
Experimental Animals ◽  
Electrophysiological Activity ◽  
Oxidation Ratio ◽  
And Shifts ◽  
Flexion And Extension

Tethered cord syndrome (TCS) is a stretch-induced functional disorder of the spinal cord. The mechanical cause of TCS is an inelastic structure anchoring the caudal end of the spinal cord that prevents cephalad movement of the lumbosacral cord. Stretching of the spinal cord occurs in patients either when the spinal column grows faster than the spinal cord or when the spinal cord undergoes forcible flexion and extension. Research in patients and experimental animals suggests that there is a link between the clinical dysfunctions that characterize TCS and putative pathophysiological changes that accompany this syndrome. Among these changes are depression of electrophysiological activity and shifts in the reduction/oxidation ratio of cytochrome oxidase. The latter suggests that there is impairment of oxidative metabolism. These putative pathophysiological changes in TCS occur mainly within the lumbosacral cord under excessive tension. The authors discuss the pathophysiology of TCS and examine related symptoms.

Long-term Risks of Persistent Ventral Spinal CSF Leaks in SIH: Superficial Siderosis and Bibrachial Amyotrophy

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012786
Author(s):  
Wouter I. Schievink ◽  
Marcel Maya ◽  
Franklin Moser ◽  
Miriam Nuño
Keyword(s):  
Spinal Cord ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Superficial Siderosis ◽  
Spinal Cord Herniation ◽  
Neurologic Disability ◽  
One Year ◽  
Csf Leaks

Background and Objectives:Superficial siderosis, bibrachial amyotropy, and spinal cord herniation are unusual but serious long-term sequelae of persistent spontaneous spinal CSF leaks in patients with spontaneous intracranial hypotension (SIH), particularly ventral spinal CSF leaks. However, the risk of developing such sequelae has not been established in this population. We undertook this study to determine the risk of these serious complications of persistent ventral spinal CSF leaks.Methods:This cohort study was conducted using data from a prospectively maintained data base of patients who meet the modified International Classification of Headache Disorders (ICHD)-III criteria for SIH. The patient population consisted of a consecutive group of patients with SIH and persistent ventral spinal CSF leaks, who were first seen within one year of onset of SIH symptoms and who had at least one year of follow-up.Results:Among 51 patients with SIH and a persistent ventral spinal CSF leak, superficial siderosis developed in six patients and bibrachial amyotropohy in two patients during 280 patient years of follow-up. The probability of these complications increased from 0% at 48 months, to 4.5% (95% confidence interval (CI): 1.0-28.0%) at 56 months, 10.5% (95% CI: 3.0-36.4%) at 96 months, 32.7% (95% CI: 15.0-62.8%) at 144 months, and 57.9% (95% CI: 30.2-87.6%) at 192 months. None of the patients developed spinal cord herniation.Discussion:Among patients with SIH and a persistent ventral spinal CSF leak, the risk of developing serious long-term sequelae is considerable. This study shows that early treatment of a ventral spinal CSF leak offers a unique opportunity to prevent neurologic disability from superficial siderosis and bibrachial amyotrophy.

Tethered Cord Syndrome in Children – Report of Two Cases

2017 ◽  
Vol 71 (2) ◽  
pp. 136-139
Author(s):  
Filip Duma ◽  
Sonja Bojadzieva ◽  
Aspazija Sofijanova ◽  
Ana Stamatova ◽  
Angelcho Andonovski ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Column ◽  
Tethered Cord ◽  
Final Diagnosis ◽  
Diagnostic Methods ◽  
Tethered Spinal Cord ◽  
Resonance Imaging ◽  
Early Diagnostics ◽  
Clinical Indicators ◽  
Age Dependent

Abstract Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. Attachments may occur congenitally at the base of the spinal cord (medullary cone) or they may develop near the site of an injury to the spinal cord. These attachments cause an abnormal stretching of the spinal cord. The course of the disorder is progressive. We present two patients that were diagnosed at age of three months and three years, respectively. Final diagnosis was made by magnetic resonance imaging, and both patients were referred to University Clinic of Neurosurgery for further treatment. Our aim is to illustrate the advantages of the early diagnostics of this progressive condition, to present diagnostic methods that are age-dependent and to illustrate the early clinical indicators for its existence.

Metastatic spinal cord compression

2020 ◽  
Vol 81 (4) ◽  
pp. 1-10
Author(s):  
Surendra Patnaik ◽  
Joseph Turner ◽  
Praveen Inaparthy ◽  
Will KM Kieffer
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cauda Equina ◽  
Spinal Column ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Neurological Injury ◽  
Clinical Approach ◽  
Mobility Function ◽  
Ongoing Development

Metastatic spinal cord compression is compression of the spinal cord or cauda equina as a result of metastatic deposits in the spinal column. It affects approximately 4000 cases per year in England and Wales. Prompt identification and treatment of metastatic spinal cord compression is necessary to prevent irreversible neurological injury, treat pain and maintain patients' mobility, function and independence. Survival of patients with common malignancies has improved significantly with the ongoing development of radiotherapy and chemotherapy, as well as improved surgical treatment of resectable primary tumours. This article outlines the clinical approach to presentation, pathophysiology, diagnosis and management.

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