Abstract
Spine shortening via vertebral osteotomy (SSVO) for recurrent tethered cord syndrome (TCS) is a novel surgical technique that avoids the complication profile associated with revision detethering. While SSVO has previously been described via a posterior approach, we describe a lateral retropleural approach for SSVO in recurrent TCS in a 21-year-old female.Our patient presented with progressive lower extremity weakness, bowel and bladder incontinence, and back pain in the setting of childhood repair of myelomeningocele and two previous detethering procedures. SSVO was offered to the patient as further detethering was deemed to have significant risk. A discectomy at T11-T12 via the lateral retropleural approach was performed, followed by a T12 partial corpectomy removing the vertebral body down to the inferior aspect of the T12 pedicle, followed by the removal of the ipsilateral pedicle. The T10, T11, L1, and L2 pedicle screws were then placed in the prone position and temporary rods were placed for temporary stability, followed by a laminectomy at T12 and a facetectomy for posterior element release. The remaining pedicle was removed, permanent rods were sequentially placed, and spinal column shortening was achieved by compression against the rods. Standing lateral radiographs demonstrated 19 millimeters (mm) of shortening after the intervention. The patient remained at her neurologic baseline postoperatively. At the six-month follow-up, the patient reported decreased lower extremity radicular pain and improved bowel and bladder function.This operative report demonstrates that SSVO via a lateral retropleural approach is a viable treatment for the recurrence of TCS. The advantages of this minimally invasive approach compared to the posterior approach are direct access to the vertebral body and disc space, avoiding the need to operate around the spinal cord. Further studies are necessary to assess this minimally invasive approach to spinal shortening and to see if a complete minimally invasive approach is possible.
Highlights
Tethered cord syndrome (TCS) is a progressive neurologic condition due to vertical traction and the stretching of the spinal cord, causing lower back pain, leg pain, lumbosacral weakness, How to cite this article Steinberg J A, Wali A R, Martin J, et al (August 31, 2017) Spinal Shortening for Recurrent Tethered Cord Syndrome via a Lateral Retropleural Approach: A Novel Operative Technique
The T10, T11, L1, and L2 pedicle screws were placed in the prone position and temporary rods were placed for temporary stability, followed by a laminectomy at T12 and a facetectomy for posterior element release
This procedure indirectly reduces traction on the spinal cord by shortening the length of the spinal column. Reports of this procedure describe a posterior approach with comparable outcomes to successful redo detethering while significantly reducing the complications of cerebrospinal fluid (CSF) leak and direct spinal cord injury [16,17]. In this operative case report, we describe the first lateral approach to Spine shortening via vertebral osteotomy (SSVO) for recurrent TCS in a patient with a history of spina bifida
Summary
Tethered cord syndrome (TCS) is a progressive neurologic condition due to vertical traction and the stretching of the spinal cord, causing lower back pain, leg pain, lumbosacral weakness, How to cite this article Steinberg J A, Wali A R, Martin J, et al (August 31, 2017) Spinal Shortening for Recurrent Tethered Cord Syndrome via a Lateral Retropleural Approach: A Novel Operative Technique. Reports of this procedure describe a posterior approach with comparable outcomes to successful redo detethering while significantly reducing the complications of CSF leak and direct spinal cord injury [16,17] In this operative case report, we describe the first lateral approach to SSVO for recurrent TCS in a patient with a history of spina bifida. She could ambulate for much of her daily activities with only the use of an ankle and foot orthoses, an improvement from her normal use of her walker. Sagittal alignment is maintained with early fusion demonstrated at the vertebral osteotomy site (demarcated by the red arrow)
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