title: Reduction of caudal traction force using dural sac opening rather than spinal cord detethering for tethered cord syndrome caused by lipomyelomeningocele: a case report.
abstract: BACKGROUND
  A few reports have addressed tethered cord syndrome. Detethering surgery has been performed in these cases because abnormal tension on the spinal cord causes neurologic and urologic symptoms.
  
  
  OBJECTIVE
  To discuss the surgical treatment of tethered cord syndrome with the belief that the tension on the cord can be decreased by shifting tethered cord to the dorsal side.
  
  
  METHODS
  A patient with tethered cord syndrome was surgically treated by shifting the tethered cord to the dorsal side by harnessing the lumbar lordosis instead of detethering.
  
  
  METHODS
  We performed surgery to shift the tethered cord to the dorsal side by harnessing the lumbar lordosis to decrease the tension on the spinal cord.
  
  
  RESULTS
  The tethered cord that was pressed to the ventral side because of a lipoma was shifted dorsally by laminectomy and opening of the dural sac. Pain and numbness were alleviated immediately after surgery.
  
  
  CONCLUSIONS
  The method used in the present case, that is, shifting the tethered cord and lipoma to the dorsal side by harnessing the lumbar lordosis instead of detethering, is a viable treatment option for tethered cord syndrome.
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan. Electronic address: yasuakimurata@ort.twmu.ac.jp.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Murata
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan.
authors.forename: Kohichi
authors.initials: K
authors.lastname: Kanaya
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Wada
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Wada
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shiba
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kato
mesh_terms: D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008067:Lipoma / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008591:Meningomyelocele / Q000150:complications* / Q000601:surgery; D008875:Middle Aged; D009436:Neural Tube Defects / Q000209:etiology / Q000601:surgery*; D010146:Pain / Q000601:surgery; D013116:Spinal Cord / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D014143:Traction; D016896:Treatment Outcome
keywords: Detethering; Dural sac opening; Laminectomy; Lipomyelomeningocele; Lumbar lordosis; Tethered cord syndrome