Our Summary

This research paper introduces a new surgical technique for treating tethered cord syndrome (TCS), a condition that can cause a progressive decline in neurological function. The standard treatment for TCS involves a surgical procedure to release the spinal cord, but in 5% to 50% of cases, the cord may retether, leading to the reappearance of symptoms.

The authors report a successful treatment of TCS in a 31-year-old man who had experienced a decline in his ability to walk, muscle weakness in his legs, loss of bladder and bowel control, and sensory loss, all symptoms of TCS. He had previously undergone a standard surgical procedure to release his spinal cord, but his condition had worsened due to retethering of his spinal cord.

The new procedure, guided by a tool called an O-arm navigation, involved two steps: first, removing a portion of the spinal disc from the front (anterior) side of the body; and then, performing a type of bone-cutting surgery (osteotomy) from the back (posterior) side, shortening the spinal column by 15 millimeters.

Post-surgery, the patient’s spinal cord tension was successfully released, and his muscle strength and sensory function had almost completely returned after a year. The authors conclude that this new procedure could be a promising alternative treatment for cases where the spinal cord retethers after the standard surgery.

FAQs

  1. What is the standard treatment for Tethered Cord Syndrome (TCS) and how effective is it?
  2. What is the new surgical technique proposed for the treatment of TCS and how does it differ from the standard procedure?
  3. What were the results of the new procedure in the case of the 31-year-old man?

Doctor’s Tip

One helpful tip a doctor might tell a patient about detethering surgery is to follow post-operative care instructions carefully to ensure a successful recovery. This may include restrictions on physical activity, proper wound care, and attending follow-up appointments with the medical team. It is important for the patient to communicate any concerns or changes in symptoms to their healthcare provider promptly.

Suitable For

Patients who are typically recommended detethering surgery for TCS are those who have experienced symptoms such as progressive decline in neurological function, muscle weakness in the legs, loss of bladder and bowel control, sensory loss, and difficulty walking. These patients may have already undergone a standard surgical procedure to release the spinal cord but have experienced a recurrence of symptoms due to retethering of the spinal cord. In these cases, detethering surgery may be recommended to release the spinal cord tension and improve neurological function.

Timeline

  • Before surgery: The patient experiences symptoms such as decline in walking ability, muscle weakness in legs, loss of bladder and bowel control, and sensory loss due to tethered cord syndrome.
  • Standard surgical procedure is performed to release the spinal cord, but symptoms worsen due to retethering.
  • New surgical technique is performed using O-arm navigation, involving removal of spinal disc from the front and bone-cutting surgery from the back to release spinal cord tension.
  • Post-surgery: Patient experiences almost complete return of muscle strength and sensory function after a year, indicating successful treatment of tethered cord syndrome.

What to Ask Your Doctor

Some questions a patient should ask their doctor about detethering surgery include:

  1. What is the success rate of this new surgical technique compared to the standard procedure for treating tethered cord syndrome?
  2. What are the potential risks and complications associated with this new procedure?
  3. How long is the recovery process after undergoing detethering surgery?
  4. Will I need physical therapy or other rehabilitation after the surgery?
  5. How long do the effects of the surgery typically last before the spinal cord may potentially retether again?
  6. Are there any lifestyle changes or restrictions I need to follow after the surgery to prevent the spinal cord from retethering?
  7. How soon after the surgery can I expect to see improvements in my symptoms?
  8. Are there any long-term effects or risks associated with this new surgical technique?
  9. Will I need follow-up appointments or tests to monitor the success of the surgery?
  10. Are there any alternative treatments or therapies available for tethered cord syndrome if the surgery is not successful?

Reference

Authors: Tanaka M, Sonawane S, Arataki S, Fujiwara Y, Taoka T, Uotani K, Oda Y, Shinohara K. Journal: Medicina (Kaunas). 2023 Dec 22;60(1):20. doi: 10.3390/medicina60010020. PMID: 38256281