Tethered spinal cord syndrome with lumbar segmental stenosis treated with XLIF

A Transforaminal Endoscopic Surgical Technique for Treating Lumbar Disc Herniation in the Setting of Spina Bifida

“…is technique is widely employed with great success to treat degenerative spine disease via a lateral, retroperitoneal, transpsoas approach [34]. Indeed, the success of LLIF was recently highlighted in a case report of a patient with tethered cord who developed stenosis due to lumbar disc herniation at L3-4 [6]. Unfortunately, for our patient several relative contraindications for utilizing LLIF exist.…”

“…Given this information, it is presumed that the U.S. population's burden of disease from cooccurring lumbar disc herniation and spina bifida is not insignificant, as the prevalence of spina bifida alone is estimated to be between 10 and 20% [4,5]. Unfortunately, literature about the surgical management of lumbar disc herniation in the adult patient with spina bifida remains strikingly sparse [6][7][8][9].…”

Spinal Cord Tethering, a Very Rare Cause of Cauda Equina Syndrome after Lumbar Disk Surgery: A Case Report

“…Although untethering procedure during or after the decompressive surgery in such cases is still in question, especially if patients symptoms could be attributed only to herniated disk and nerve root compression (Endo et al, 2014;Carpineta et al, 2017); it seems that untethering in our case after clarifying underlying disease should be advisable. However, a bright signal on T2 weighted images on postoperative MRI in conus medullaris points to concomitant traumatic contusion within the terminal of cord and poor prognosis for any further treatment (Ramon et al, 1997).…”

“…Surely, these special cases should be managed as a thoracic disc herniation. In this case, decompression of neural elements must be performed with minimal traction on the dural sac, for example using transfacet or even anterolateral approaches (Endo et al, 2014;Carpineta et al, 2017). Moreover, intraoperative neuromonitoring could be used before the surgery, if the diagnosis of TCS would be made preoperative.…”

“…Rarely, the patients remain asymptomatic to adulthood. In some of these patients, precipitating factors such as trauma or spinal degenerative conditions exacerbate neurological symptoms, and patients can present with tethered cord syndrome (Srinivas et al, 2012;Carpineta et al, 2017). On the other hand, TCS is an error of spinal cord developmental process which could show neurological signs and symptoms in childhood or adulthood due to tension on conus medullaris (Lapsiwala and Iskandar, 2004;Yamada et al, 2004).…”