A Novel Minimally Invasive Technique for Spinal Cord Untethering

Abstract Objective: Minimally invasive surgical techniques have been described for the treatment of spinal pathology. Tethered cord syndrome is an under-diagnosed condition of abnormally rigid fixation of the spinal cord that results in spinal cord tension leading to ischemia. It can be the cause of incontinence, scoliosis, and chronic back and leg pain. In situations of spinal cord tether owing to fatty filum or tight filum terminale, the symptoms can be relieved by sectioning of the filum. We present a novel, minimally invasive technique for surgical untethering of the spinal cord by filum sectioning. The patho-physiology of tethered spinal cord and the advantages of minimally invasive surgical management of this entity are discussed. Methods: Three patients (ages 14, 35, and 46 yr) presented with long-standing leg and back pain and neuroradiological features of tethered cord syndrome and thickened, fatty filum terminale. Two patients presented with scoliosis and, upon further history, had subclinical incontinence; one of these patients had abnormal urodynamic studies. Results: All three patients underwent a minimally invasive approach to the L4/L5 level using the X-tube (Medtronic, Inc., Memphis, TN). A laminotomy was performed and the dura exposed. The dura was then opened and intradural microdissection delivered the fatty filum into the durotomy. Electrical stimulation was performed while the lower extremities and the anal sphincter were monitored for electromyographic activity. After acquisition of positive controls, the filum was identified by the lack of sphincter and lower extremity electromyographic responses and was then cauterized and cut. Dura was repaired with the use of endoscopic instrumentation. All patients had significant improvement of their leg and back pain, and one patient had resolution of the abnormal urodynamics. Conclusion: Tethered spinal cords can be safely and effectively untethered using minimally invasive surgery. This technique provides the advantage of reduced soft tissue injury, less postoperative pain, minimal blood loss, a smaller incision, and a shorter hospitalization. The minimal amount of tissue injury generated by this technique may also provide the added advantage of reduced scar formation and risk of retethering.

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Multicolumn Spinal Cord Stimulation Surgical Lead Implantation Using an Optic Transligamentar Minimally Invasive Technique

Global Spine Journal ◽

10.1055/s-0036-1583017 ◽

2016 ◽

Vol 6 (1_suppl) ◽

pp. s-0036-1583017-s-0036-1583017

Author(s):

Philippe Cam ◽

Olivier Monlezun ◽

Bertille Lorgeoux ◽

Manuel Roulaud ◽

Philippe Rigoard

Keyword(s):

Spinal Cord ◽

Minimally Invasive ◽

Spinal Cord Stimulation ◽

Minimally Invasive Technique ◽

Invasive Technique

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Adipose Tissue in the Filum Terminale: A Computed Tomographic Finding That May Indicate Tethering of the Spinal Cord

Neurosurgery ◽

10.1227/00006123-198805000-00010 ◽

1988 ◽

Vol 22 (5) ◽

pp. 873-876 ◽

Cited By ~ 63

Author(s):

Roger E. McLendon ◽

Jerry W. Oakes ◽

Ralph E. Heinz ◽

Andrew E. Yeates ◽

Peter C. Burger

Keyword(s):

Spinal Cord ◽

Adipose Tissue ◽

Low Back Pain ◽

Back Pain ◽

Ct Scan ◽

Tethered Cord ◽

Ct Scanning ◽

Low Back ◽

Filum Terminale ◽

Computed Tomographic

Abstract Adipose tissue in the filum terminale is frequently associated with tethering of the spinal cord in patients with spina bifida occulta (3, 8). We recently saw a patient with low back pain and no spina bifida occulta, in whom adipose tissue was noted in the area of the filum on an unenhanced computed tomographic (CT) scan. The patient had a tethered cord. This case suggested that, when CT scanning is done as the first imaging study in the evaluation of low back pain, fatty tissue in the area of the filum may be an indicator for tethering of the spinal cord. The present study was undertaken to determine the validity of using CT scan-detectable filal fat in the identification of possible tethered spinal cords among a group of patients experiencing low back pain. The presence of fat in the fila of 12 patients with the radiologically and histologically tethered cord syndrome was evaluated and the fila of 47 autopsied patients whose clinical history showed no back pain were examined histologically. There were accumulations of adipose tissue in the fila of 11 of the 12 (91%) patients with the tethered cord syndrome and in the fila of 9 of the 47 patients (17%) in the autopsy series. Of the 9 autopsy patients with fat in their fila, however only 3 patients (6%) exhibited collections of adipose tissue in the CT detection range (2 mm). These results demonstrate that, although CT scan-detectable adipose tissue can be found in the filum of an occasional patient without tethered cord, CT detectable fat in the filum of a patient with low back pain should prompt an evaluation for a tethered spinal cord. CT scanning has potential as a noninvasive tool in such a work-up.

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Description of a minimally invasive technique with a modified instrument for the osteosynthesis of proximal femoral fractures using the standard DHS and case series

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20202590 ◽

2020 ◽

Vol 47 ◽

Author(s):

RICARDO RAMON CAMACHO IRIGOYEN ◽

RAFAEL DE LUCA DE-LUCENA ◽

JEAN KLAY SANTOS MACHADO ◽

GABRIEL SEVERO DA-SILVA ◽

CARLOS ROBERTO SCHWARTSMANN ◽

...

Keyword(s):

Minimally Invasive ◽

Surgical Techniques ◽

Case Series ◽

Femoral Fractures ◽

Soft Tissue Injuries ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Trochanteric Fractures ◽

Clinical Complications ◽

Minimally Invasive Surgical

ABSTRACT Introduction: the number of hip fractures is estimated to increase from 1.66 million in 1990 to 6.26 million by 2050. Internal fixation is the most common surgical treatment for intertrochanteric fractures. Objectives: the objective of the present research is to describe a minimally invasive technique with a modified instrument for the treatment of stable proximal femoral trochanteric fractures using the standard DHS, classified as Tronzo types 1 and 2 (AO 31A1.2), and presenting a case series. Methods: a case was selected to present the technique. Patients operated by this technique undergo a clinical evaluation and preoperative preparation as routine. The criteria for inclusion in the study were the presence of stable fracture of the proximal femur verified by two hip specialist orthopedists, and operated by the minimally invasive technique with a modified instrument using a standard DHS. Exclusion criteria were cases of patients operated for unstable fractures, and the use of other surgical techniques. A case series of 98 patients was performed and discussed. Results: minimally invasive technique with a modified instrument using the standard DHS device can reduce bleeding, it decreases soft tissue injuries, surgical time, and hospital stay, as any other MIPO procedures. Ninety-eight patients underwent the operation (Tronzo types I and II), 59 female and 39 male, ages from 50 to 85 years old. Immediate post-operative complications were shortening of the lower limb, loss of fracture reduction, and death by clinical complications. Conclusion: the present study describes a minimally invasive surgical technique using a modified instrument to perform proximal femoral osteosynthesis for stable trochanteric fractures, using the standard DHS.

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Significant clinical and radiological resolution of a spinal cord syrinx following the release of a tethered cord in a patient with an anatomically normal conus medullaris

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/5/396 ◽

2008 ◽

Vol 1 (5) ◽

pp. 396-398 ◽

Cited By ~ 11

Author(s):

John Caird ◽

Peter Flynn ◽

Robert S. McConnell

Keyword(s):

Spinal Cord ◽

Neurological Deficit ◽

Tethered Cord ◽

Conus Medullaris ◽

Tethered Cord Syndrome ◽

Current Understanding ◽

Filum Terminale ◽

Ongoing Debate ◽

Progressive Neurological Deficit

✓The authors describe a case of progressive neurological deficit caused by syringomyelia in a 7-year-old boy with a normally positioned conus medullaris. This deficit responded favorably to surgical untethering of the filum terminale, with subsequent clinical and radiological improvement. The authors discuss the implications of their findings in the context of the current understanding of the pathophysiology of tethered cord syndrome, particularly in relation to the ongoing debate in the neurosurgical literature.

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Spinal cord traction, vascular compromise, hypoxia, and metabolic derangements in the pathophysiology of tethered cord syndrome

Neurosurgical FOCUS ◽

10.3171/2010.3.focus1085 ◽

2010 ◽

Vol 29 (1) ◽

pp. E9 ◽

Cited By ~ 37

Author(s):

Aristotelis S. Filippidis ◽

M. Yashar Kalani ◽

Nicholas Theodore ◽

Harold L. Rekate

Keyword(s):

Spinal Cord ◽

Blood Flow ◽

Clinical Picture ◽

Tethered Cord ◽

Conus Medullaris ◽

Tethered Cord Syndrome ◽

Structural Abnormality ◽

Filum Terminale ◽

Radiological Criteria ◽

Definition Of

Object The definition of tethered cord syndrome (TCS) relies mainly on radiological criteria and clinical picture. The presence of a thickened filum terminale and a low-lying conus medullaris in symptomatic patients is indicative of TCS. The radiological definition of TCS does not take into account cases that involve a normal-lying conus medullaris exhibiting symptoms of the disease. Methods The authors performed a MEDLINE search using the terms “tethered cord” and “pathophysiology.” The search returned a total of 134 studies. The studies were further filtered to identify mostly basic research studies in animal models or studies related to the biomechanics of the filum terminale and spinal cord. Results Spinal cord traction and the loss of filum terminale elasticity are the triggers that start a cascade of events occurring at the metabolic and vascular levels leading to symptoms of the disease. Traction on the caudal cord results in decreased blood flow causing metabolic derangements that culminate in motor, sensory, and urinary neurological deficits. The untethering operation restores blood flow and reverses the clinical picture in most symptomatic cases. Conclusions Although classically defined as a disease of a low-lying conus medullaris, the pathophysiology of TCS is much more complex and is dependent on a structural abnormality, with concomitant altered metabolic and vascular sequelae. Given the complex mechanisms underlying TCS, it is not surprising that the radiological criteria do not adequately address all presentations of the disease.

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Multicolumn spinal cord stimulation surgical lead implantation using an optic transligamentar minimally invasive technique

Journal of the Neurological Sciences ◽

10.1016/j.jns.2015.08.310 ◽

2015 ◽

Vol 357 ◽

pp. e93

Author(s):

P. Cam ◽

P. Rigoard ◽

O. Monlezun ◽

B. Lorgeoux ◽

M. Roulaud ◽

...

Keyword(s):

Spinal Cord ◽

Minimally Invasive ◽

Spinal Cord Stimulation ◽

Minimally Invasive Technique ◽

Invasive Technique

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Comparative Assessment of Original vs. Standard Surgery Techniques in Treatment for Purulent Pyelonephritis

Creative Surgery and Oncology ◽

10.24060/2076-3093-2021-11-4-288-292 ◽

2021 ◽

Vol 11 (4) ◽

pp. 288-292

Author(s):

V. A. Ananev ◽

V. N. Pavlov ◽

A. M. Pushkarev

Keyword(s):

Minimally Invasive ◽

Surgical Techniques ◽

Pain Syndrome ◽

Cortical Layer ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Intraarterial Infusion ◽

Minimally Invasive Surgical ◽

Destructive Processes ◽

Laparoscopic Techniques

Background. Modern minimally invasive surgical techniques reduce traumatism of operative interventions and aggressive anaesthesia, which accordingly shortens the patient’s hospital stay and rehabilitation period.Aim. An improvement of surgical outcomes in patients with purulent pyelonephritis via introduction of laparoscopic techniques.Materials and methods. Th e study included 80 purulent pyelonephritis patients operated at the Territorial Clinical Hospital during 2006—2018. Th e patients were divided between two cohorts. Cohort 1 included 40 (50 %) patients operated with standard techniques (ST), cohort 2 — 40 (50 %) patients having surgery by an original minimally invasive technique (OT). Kidney decapsulation was found to outcome in parenchymal decompression and blood circulation restore in cortical layer. Intraarterial infusion of alprostadil prevents further spread of purulent-destructive processes in kidney.Results and discussion. In patients with the minimally invasive technique, postoperative period proceeded at no complications. On day 1, the patients reported reduced pain syndrome in the surgical area. Contrasted renal MSCT before and aft er surgery showed the recovery of renal blood flow and significant diminishing of destruction foci in short term. Nephrectomy was not performed as no-indication.Conclusion. The treatment outcomes in 40 patients having the new surgical technique demonstrate its efficacy and applicability in clinical practice.

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TULAA: A Minimally Invasive Appendicectomy Technique for the Paediatric Patient

Minimally Invasive Surgery ◽

10.1155/2016/6132741 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Giordano Perin ◽

Maria Grazia Scarpa

Keyword(s):

Paediatric Patient ◽

Minimally Invasive ◽

Peritoneal Cavity ◽

Surgical Approach ◽

Surgical Outcomes ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Minimally Invasive Surgical ◽

Invasive Surgical Approach ◽

Laparoscopic Assisted

TULAA or Transumbilical Laparoscopic Assisted Appendicectomy is a minimally invasive technique described by Pelosi in 1992 for the removal of the inflamed appendix. Its main advantage is the possibility of exploring the peritoneal cavity and performing a simple and safe extracorporeal appendicectomy. Since its first description, different authors reported their experience with such technique. The aim of this review is to summarise the surgical outcomes currently reported in the literature for this minimally invasive surgical approach and compare it with standard open and laparoscopic appendicectomy.

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