Introduction: Minimally invasive spinal operations have become more prevalent in the past decade and indications are expanding. Tethered cord syndrome (TCS) refers to an abnormally low-lying conus medullaris. Most children present with symptoms such as chronic back pain, leg weakness, incontinence, or scoliosis. We present the first series of minimally invasive muscle sparing tethered cord release (TCR) in the pediatric population.
Methods: A retrospective review of the Texas Children's Hospital Neurosurgical database was conducted for patients that underwent surgical release of tethered spinal cord between 2010 and 2017. Charts were reviewed to determine the source of TCS and if TCR was conducted in a minimally invasive fashion. Exclusion criteria were non-fatty filum sources of TCS. The length of stay, operative time, estimated blood loss (EBL), and post-operative complications were recorded.
Results: Twelve pediatric patients underwent minimally invasive TCR. Mean age of the patients was 9 years (range 2 - 18 years). All patients underwent L4-5 laminotomy using the METRX tube (Medtronic, Inc., Memphis, TN) and minimally invasive cord detethering by two senior pediatric neurosurgeons at Texas Children's Hospital. Eleven patients (92%) underwent successful release of tethered spinal cord while one patient was converted to the traditional open approach. The average length of stay in the hospital was 2.8 days. The average OR time was 2 hours and 50 minutes and average EBL was 10.8 cc. Eleven patients reported clinical improvement at follow up visit (92%). One case was complicated by delayed CSF leak and post-operative meningitis, requiring surgical repair.
Conclusions: Minimally invasive muscle-splitting tethered cord release is a safe and effective operation. It represents a viable alternative to open surgery and laminectomy for TCR. Minimally invasive surgery has considerable advantages, including reduced OR time, minimal EBL, shortened length of stay and post-operative pain control.
Patient Care: Minimally invasive muscle-splitting tethered cord release offers an alternative approach to traditional laminectomy for treatment of tethered cord syndrome. This approach creates less dead-space, less soft tissue/muscle damage, and thereby minimizes post operative pain, possibility of CSF leak, and length of stay.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) have a thorough understanding of various surgical approaches for tethered cord release
2) learn about advantages of minimally invasive tethered cord release over the traditional open approach
3) understand limitations and possible complications of minimally invasive spinal operation