Spinal shortening osteotomy for adult tethered cord syndrome evaluated by intraoperative ultrasonography.

Abstract

BACKGROUND:

Spinal shortening osteotomy (SSO) reduces the tension indirectly in the spinal cord and minimizes perioperative complications. However, the most effective and safe length to which the spine can be shortened is still unknown. In our practice, we use somatosensory-evoked potentials, motor-evoked potentials, and intraoperative ultrasonography when performing SSO. This study aimed to introduce the clinical outcomes of our SSO technique for tethered cord syndrome (TCS) in adults.

METHODS:

This retrospective study included 7 adult patients (2 males and 5 females) with TCS treated between December 2010 and December 2018. The average age and average preoperative duration were 40 and 5 years, respectively. All patients received SSO with somatosensory-evoked potentials, motor-evoked potentials, and ultrasonography. After surgery, all patients were followed for an average of 4 years.

RESULTS:

The mean operation time was 328 (284-414) min for SSO. The mean blood loss was 828 ml (501-1252 ml). Postoperative bony fusion was confirmed in all patients. Postoperative computed tomography (CT) demonstrated an average of 16 mm (11-20 mm) of spinal column shortening, compared with preoperative CT. Clinical improvements were obtained in all 7 cases, and there was no case of exacerbation. An indicator of shortening is that the ultrasonography gives pulsation and relaxation of the spinal cord. There were no abnormalities observed while monitoring the spinal cord.

CONCLUSIONS:

Spinal shortening should be done under somatosensory-evoked potentials, motor-evoked potentials, and intraoperative ultrasonography to obtain safe and sufficient shortening.

• Authors: Koichiro Ide, Tomohiko Hasegawa, Yu Yamato, Go Yoshida, Tatsuya Yasuda, Tomohiro Banno, Hideyuki Arima, Shin Oe, Hiroki Ushirozako, Tomohiro Yamada, Yuh Watanabe, Sho Kobayashi, Yukihiro Matsuyama
• Journal: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association (J Orthop Sci) Vol. 26 Issue 3 Pg. 363-368 (May 2021) ISSN: 1436-2023 [Electronic] Japan
• PMID: 32703626 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Topics

• Adult
• Female
• Humans
• Male
• Neural Tube Defects (diagnostic imaging, surgery)
• Osteotomy
• Retrospective Studies
• Spinal Cord
• Spine
• Ultrasonography