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Shortening vertebrotomy for recurrent tethered cord syndrome in children

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Introduction: tethered cord syndrome (TCS) caused by spinal cord tension due to tethering of its caudal part in the lumbosacral spinal canal. The main purpose of surgical treatment of TCS is to release the structures of spinal cord from excessive tension. The traditional method of TCS treatment involves microsurgical elimination of tethering factors and excision of the filum terminale. In the cases of recurrent TCS surgical manipulations raise the risk of damage of spinal cord and its roots and in some cases tethered cord release is impossible. The shortening vertebrotomy was proposed as an alternative to microsurgical treatment for the recurrent tethered cord syndrome in adults. There are no reports of using shortening vertebrotomy in children with TCS.


Subject: 6 years old boy with history of myelomeningocele repair was examined.  Complaints were lumbar pain, leg weakness, urinary and fecal incontinence. MRI showed multi-level spine and spinal cord malformations: spina bifida, tethered spinal cord at L5-S1 level,  butterfly L2 vertebra, type II split cord malformation at L2 level, scoliotic spinal deformity (Fig. 1).

Methods: transpedicular L2 vertebra resection, transpedicular fixation at Th12-L4 levels and contraction (decrease in the height of the vertebral column for 20 mm) were performed (Fig. 2, 3).

Results: reduction pain, increase in muscle strength of the lower limbs, better control over bowel and bladder functions were observed within 2 years of follow-up after surgery. Thus, regress of TCS was observed after spine shortening without manipulation on the tethering site.

Conclusions: the shortening vertebrotomy can be considered as an alternative method to surgical treatment for some children with recurrent TCS when additional indications exist.

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