Posterior vertebral column subtraction osteotomy: a novel surgical approach for the treatment of multiple recurrences of tethered cord syndrome.
Recurrent tethered cord syndrome (TCS) has been reported to develop in 5-50% of patients following initial spinal cord detethering operations. Surgery for multiple recurrences of TCS can be difficult and is associated with significant complications. Using a cadaveric tethered spinal cord model, Grande and colleagues demonstrated that shortening of the vertebral column by performing a 15-25-mm thoracolumbar osteotomy significantly reduced spinal cord, lumbosacral nerve root, and terminal filum tension. Based on this cadaveric study, spinal column shortening by a thoracolumbar subtraction osteotomy may be a viable alternative treatment to traditional surgical detethering for multiple recurrences of TCS. In this article, the authors describe the use of posterior vertebral column subtraction osteotomy (PVCSO) for the treatment of 2 patients with multiple recurrences of TCS. Vertebral column resection osteotomy has been widely used in the surgical correction of fixed spinal deformity. The PVCSO is a novel surgical treatment for multiple recurrences of TCS. In such cases, PVCSO may allow surgeons to avoid neural injury by obviating the need for dissection through previously operated sites and may reduce complications related to CSF leakage. The novel use of PVCSO for recurrent TCS is discussed in this report, including surgical considerations and techniques in performing PVCSO.
Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. phsieh@usc.edu
Patrick C
PC
Hsieh
Stephen L
SL
Ondra
Andrew W
AW
Grande
Brian A
BA
O'Shaughnessy
Karin
K
Bierbrauer
Kerry R
KR
Crone
Ryan J
RJ
Halpin
Ian
I
Suk
Tyler R
TR
Koski
Ziya L
ZL
Gokaslan
Charles
C
Kuntz
D000328:Adult; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008591:Meningomyelocele / Q000000981:diagnostic imaging / Q000601:surgery; D009436:Neural Tube Defects / Q000000981:diagnostic imaging / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010027:Osteotomy / Q000379:methods*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D013123:Spinal Fusion / Q000379:methods; D014057:Tomography, X-Ray Computed; D055815:Young Adult