Traction Stitch Research Articles

Posterolateral cervical or thoracic approach with spinal cord rotation for vascular malformations or tumors of the ventrolateral spinal cord.

This report describes a technique for exposing the ventrolateral quadrant of the spinal cord through an extended posterolateral approach that can be used in both cervical and thoracic regions. The surgical technique includes the following: 1) a midline skin incision with a transverse extension at the level of pathology; 2) unilateral division and retraction of the paraspinous muscles; 3) laminectomy and unilateral removal of facets and pedicles; 4) dural incision over the dorsal root entry zone; 5) multilevel division of the ipsilateral dentate ligaments; and 6) elevation and rotation of the spinal cord with dentate traction stiches. This technique provides exposure of the ventral root entry zone, the ipsilateral half of the ventral surface of the cord, and the anterior spinal artery. The surface of the spinal cord beyond the anterior spinal artery is not seen. This approach has been used for the treatment of seven ventrolateral spinal cord lesions: five spinal arteriovenous malformations (two Type II, one Type III, two Type IV), one hemangioblastoma, and one cavernous angioma. All the lesions were completely excised. Two patients had mild new neurological deficit after surgery, and one adolescent developed mild asymptomatic thoracic kyphosis, but no other spinal instability was observed over a follow-up period of 1 to 4 years. This operative approach provides significant advantages for ventrolateral perimedullary or intramedullary lesions of the cervical or thoracic spinal cord.

Pitfalls in the treatment of the Pierre Robin Syndrome

Five possibly preventable deaths occurred in a series of 28 children with the Pierre Robin Syndrome. The primary goal in management is to move the base of the tongue from the pharynx. If this cannot be done easily, the reason, such as a tight lingular frenulum, should be found. A tongue traction stitch may be adequate to relieve the obstruction, but depending upon it for long periods of time is dangerous. The most adequate tongue-lip adhesion includes a mattress suture from the base of the tongue to beneath the chin. Patients with severe micrognathia who can be maintained in a prone position should have tongue-lip adhesion before discharge from the hospital to prevent acute airway obstruction subsequently. The Pierre Robin Syndrome is not incompatible with life, but does require good clinical judgement and careful attention to detail if treatment is to be successful.