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A novel minimally invasive technique for spinal cord untethering.

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    A novel minimally invasive technique for spinal cord untethering.

    Neurosurgery. 2007 Feb;60(2 Suppl 1):70-4.

    A novel minimally invasive technique for spinal cord untethering.

    Tredway TL, Musleh W, Christie SD, Khavkin Y, Fessler RG, Curry DJ.
    Section of Neurosurgery, Pritzker School of Medicine,
    University of Chicago, Chicago, Illinois.

    OBJECTIVE: Minimally invasive surgical techniques have been described for the treatment of spinal pathology. Tethered cord syndrome is an under-diagnosed condition of abnormally rigid fixation of the spinal cord that results in spinal cord tension leading to ischemia. It can be the cause of incontinence, scoliosis, and chronic back and leg pain. In situations of spinal cord tether owing to fatty filum or tight filum terminale, the symptoms can be relieved by sectioning of the filum. We present a novel, minimally invasive technique for surgical untethering of the spinal cord by filum sectioning. The pathophysiology of tethered spinal cord and the advantages of minimally invasive surgical management of this entity are discussed. METHODS: Three patients (ages 14, 35, and 46 yr) presented with long-standing leg and back pain and neuroradiological features of tethered cord syndrome and thickened, fatty filum terminale. Two patients presented with scoliosis and, upon further history, had subclinical incontinence; one of these patients had abnormal urodynamic studies. RESULTS: All three patients underwent a minimally invasive approach to the L4/L5 level using the X-tube (Medtronic, Inc., Memphis, TN). A laminotomy was performed and the dura exposed. The dura was then opened and intradural microdissection 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. Dura was repaired with the use of endoscopic instrumentation. All patients had significant improvement of their leg and back pain, and one patient had resolution of the abnormal urodynamics. CONCLUSION: Tethered spinal cords can be safely and effectively untethered using minimally invasive surgery. This technique provides the advantage of reduced soft tissue injury, less postoperative pain, minimal blood loss, a smaller incision, and a shorter hospitalization. The minimal amount of tissue injury generated by this technique may also provide the added advantage of reduced scar formation and risk of retethering.

    PMID: 17297368 [PubMed - in process]

    “As the cast of villains in SCI is vast and collaborative, so too must be the chorus of hero's that rise to meet them” Ramer et al 2005

    Dr. Young

    What is it about this procedure that makes it "minimally invasive" if it requires removal of the lamina and opening the dura? Would you please contrast it to the more common method.

    Thank you.
    Last edited by Foolish Old; 24 Feb 2007, 12:15 PM.

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      I agree , that is one reason I posted the abstract. What makes this "minimal" or different? N=3 makes this ?
      “As the cast of villains in SCI is vast and collaborative, so too must be the chorus of hero's that rise to meet them” Ramer et al 2005


        I agree that this is not very minimally invasive. Sorry about the long delay in answering. On the other hand, I think that they are simply using the catch-phrase minimally invasive without thinking about what it means. A lot of patients are afraid of surgery and think that minimally invasive is better than regular surgery. This is not true. There are many payoffs that one makes for "minimal invasive" surgery. One of them is not being able to see what is going on. It is true that MRI now shows a lot and the surgeon knows a lot about the tissues that he/she is operating on. The second payoff is not being able to do much if you get into trouble, such as a bleeder. If a standard operating field, you can identify the bleeder, clamp it or cauterize it. When you are operating through a small tube, you may not see it, you can act quickly to stop it, and you are limited in what you can do. So, in general, unless the procedure is really well-established and people know what they are doing and have done it many times, I don't favor minimally invasive surgery.



          Sounds like exactly how they did my surgery, it wasn't minimally invasive Katherine