Delayed postoperative tethering of the cervical spinal cord.
Tethering of the spinal cord in the lumbar and sacral regions of children with congenital anomalies is a well-recognized problem; however, tethering in the cervical region has rarely been reported. A search of the literature revealed no reports of symptomatic postoperative cervical spinal cord tethering. The authors present five cases of delayed postoperative cervical spinal cord tethering and discuss the benefit of detethering in these patients. All five patients were young (16 to 42 years of age) at presentation. All had done well after an initial surgical procedure but returned between 1 and 31 years postoperatively with symptoms including severe headache, upper-extremity pain, and progressive neurological deficits. In each case, magnetic resonance imaging indicated dorsal tethering of the cord in the cervical region. Surgical exploration with microscopic sharp detethering of the cervical cord was performed on each patient with favorable results. To avoid retethering, wide Tutoplast duraplasty is recommended.
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
K A
KA
Smith
H L
HL
Rekate
D000293:Adolescent; D000328:Adult; D001099:Arachnoid / Q000473:pathology; D002574:Cervical Vertebrae; D004388:Dura Mater / Q000473:pathology / Q000637:transplantation; D005260:Female; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012021:Reflex, Abnormal; D012678:Sensation Disorders / Q000209:etiology; D013035:Spasm / Q000209:etiology; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology