Endoscopic spinal tethered cord release: operative technique.
OBJECTIVE
This study aims to describe solely endoscopic surgical techniques for the treatment of spinal pathology. Here, we present a novel endoscopic technique for surgical untethering of the spinal cord by filum sectioning and discuss endoscopic surgical management of this entity.


METHODS
Two patients (ages 8 months and 10 years) presented with leg weakness, urine and bowel dysfunction, low back and neck pain, and thickened, fatty filum terminale. The elder patient presented with clinical incontinence and abnormal urodynamic studies.


RESULTS
Both patients underwent a solely endoscopic approach using 0 degrees and 30 degrees , 4 mm in diameter and 18 cm in length rigid endoscopes via a hemilaminectomy. Intradural microdissection under a direct visualization of endoscope 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. Both patients had significant improvement of their preoperative symptoms, and one patient had resolution of the abnormal urodynamics and her Chiari symptoms.


CONCLUSIONS
Tethered spinal cords can be safely and effectively untethered endoscopically. This procedure provides the advantages of reduced soft tissue injury, less postoperative pain, minimal blood loss, a smaller incision, and a shorter hospitalization. However, whether the endoscopic untethering technique achieves benefits above those associated with the open procedure remains to be determined by a control study.
Di
Xiao
X
Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9,500 Euclid Avenue, S90, Cleveland, OH 44195, USA. dix@ccf.org
D001416:Back Pain / Q000209:etiology; D002420:Cauda Equina / Q000002:abnormalities / Q000601:surgery; D002648:Child; D004558:Electric Stimulation / Q000379:methods; D004576:Electromyography; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D018908:Muscle Weakness / Q000209:etiology; D019547:Neck Pain / Q000209:etiology; D044583:Neuroendoscopy / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D011379:Prognosis; D020127:Recovery of Function; D013116:Spinal Cord / Q000002:abnormalities / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology