Dethethering by deformity correction

Congenital kyphosis/scoliosis/ kyphoscoliosis is often associated with intraspinal anomalies such as tethered cord, Chiari deformity, and spinal cord malformations. Tethered cord syndrome is an abnormal stretching of the spinal cord inside the spinal column. Normally tethered cord syndrome refers to neurological signs and symptoms resulting from abnormal longitudinal traction. Surgical detethering is consistently reported to be effective in treating symptomatic tethered cord syndrome. A spine-shortening vertebral osteotomy is an effective approach to correct severe kyphoscoliosis. Then, we hypothesized that a spine-shortening by vertebral osteotomy/ vertebral column resection alone could simultaneously treat both kyphoscoliosis and tethered cord without necessarily doing detethering procedure.

In this case report, we present a patient with congenital kyphoscoliosis due to congenital dislocation of D12 over L1 vertebrae with tethered cord. The patient had Paraparesis and underwent posterior vertebral column resection for releasing tension on the tethered cord without a true detethering surgery by correcting the spinal deformity.

One and the half-year-old male kid from Malaysia was brought with chief complaints of reduced movements in the bilateral lower limbs since birth with dribbling of urine and colostomy since birth. On clinical examination kid was found to have kyphoscoliosis at the back since birth, neurological examination revealed the weakness of bilateral lower limb with bladder incontinence.

After radiological investigations, the kid was found to have hemivertebra at D12 with congenital dislocation of the same over L1 causing major cord compression at that level with tethering of the cord.

Management:

Under intraoperative neural monitoring through a posterior-only approach, we did vertebral column shortening by resection of the hemivertebra followed by deformity correction with the help of screws and rods. Anterior reconstruction was done with a fibular strut graft. In the postoperative period, the kid’s neurology and weakness got better.

Complex spinal surgeries (in any age group) and spinal deformity correction cases are always done under intra-operative neural monitoring, this reduces the risk of paralysis. We have a team, Here Neurosurgeons, Orthopaedic spinal surgeons, anesthetists, and neurologists work as a complete team. 

Dr. Vignesh Pushparaj MBBS.,D Ortho., AO FISS, FISS(Netherland & USA)
Consultant Orthopaedic & Spine Surgeon