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Concurrent Spinal Cord Untethering and Scoliosis Correction: Case Report

Samdani, Amer F., MD*; Asghar, JahanGir, MD*; Pahys, Joshua, MD; D’Andrea, Linda, MD; Betz, Randal R., MD*

doi: 10.1097/BRS.0b013e31815ce6ae
Case Reports
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Study Design. Case report.

Objective. To describe the technique, value, and risk of performing concomitant untethering of the spinal cord and scoliosis correction.

Summary of Background Data. The incidence of intraspinal anomalies such as tethered cord, syringomyelia, Chiari malformation, and diastematomyelia is as high as 20% in infantile or juvenile and congenital scoliosis. Intraspinal anomalies that require intervention are commonly treated before surgical correction of the scoliosis to minimize the risk of neurologic complications. To our knowledge, this is the first documentation of the concurrent performance of these 2 procedures.

Methods. A 15-year-old boy presented with progressive kyphoscoliosis as well as lower extremity parasthesias and intermittent urinary incontinence. The thoracic and lumbar curves progressed to 65 and 80 degrees, respectively, with little flexibility. Preoperative magnetic resonance imaging of the entire spine revealed a low-lying conus at L4. The patient underwent untethering of the filum terminale in addition to posterior spinal fusion from T2 to the pelvis. Intraoperative neuromonitoring included somatosensory-evoked potentials, motor-evoked potentials, continuous electromyography, triggered electromyography, and specific leads to monitor urethral and anal sphincter function.

Results. The patient tolerated the procedure well without complication. He was able to ambulate on postoperative day 2. The patient reported complete resolution of the lower extremity parasthesias and improvement in urinary symptoms. He continues to do well at 9 months after surgery.

Conclusion. Concurrent untethering of the spinal cord and scoliosis correction with adequate intraoperative neuromonitoring is a viable option compared with a staged procedure in appropriately selected patients.

Concurrent untethering of the spinal cord and scoliosis correction with adequate intraoperative neuromonitoring is a viable option compared with a staged procedure in appropriately selected patients.

From the *Shriners Hospital for Children, Philadelphia, Pennsylvania; †Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania; and ‡Brandywine Institute of Orthopedics, Pottstown, Pennsylvania.

Acknowledgment date: April 2, 2007. Revision date: May 25, 2007. Acceptance date: August 2, 2007.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Amer F. Samdani, MD, Shriners Hospitals for Children, Philadelphia, 3551 North Broad Street, Philadelphia, PA 19140; Email: amersamdani@yahoo.com

© 2007 Lippincott Williams & Wilkins, Inc.