Concurrent Spinal Cord Untethering and Scoliosis Correction

Abstract

Case report. To describe the technique, value, and risk of performing concomitant untethering of the spinal cord and scoliosis correction. The incidence of intraspinal anomalies such as tethered cord, syringomyelia, Chiari malformation, and diastematomyelia is as high as 20% in infantile or juvenile and congenital scoliosis. Intraspinal anomalies that require intervention are commonly treated before surgical correction of the scoliosis to minimize the risk of neurologic complications. To our knowledge, this is the first documentation of the concurrent performance of these 2 procedures. A 15-year-old boy presented with progressive kyphoscoliosis as well as lower extremity parasthesias and intermittent urinary incontinence. The thoracic and lumbar curves progressed to 65 and 80 degrees, respectively, with little flexibility. Preoperative magnetic resonance imaging of the entire spine revealed a low-lying conus at L4. The patient underwent untethering of the filum terminale in addition to posterior spinal fusion from T2 to the pelvis. Intraoperative neuromonitoring included somatosensory-evoked potentials, motor-evoked potentials, continuous electromyography, triggered electromyography, and specific leads to monitor urethral and anal sphincter function. The patient tolerated the procedure well without complication. He was able to ambulate on postoperative day 2. The patient reported complete resolution of the lower extremity parasthesias and improvement in urinary symptoms. He continues to do well at 9 months after surgery. Concurrent untethering of the spinal cord and scoliosis correction with adequate intraoperative neuromonitoring is a viable option compared with a staged procedure in appropriately selected patients.