脊髄係留症候群に対する腰椎短縮, 椎間固定による一治療経験  [in Japanese] A Case with Tethered Cord Syndrome treated by Shortening of the Lumbar Spinal Canal Length with Interbody Fusion  [in Japanese]

The authors reported a unique treatment of shortening of the lumbar spine with interbody fusion to an adult case with tethered cord syndrome. A 40-year-old male, who had a history of the operation for ankylosing bilateral his foot joints, noted progressive paraparesis for the last several years. He could ambulate with canes. He was diagnosed as suffering from a tethered cord syndrome by a complicated lumbosacral lipoma with the dysraphism, which did not seem to be easily removed or detached from the caudal part of the spinal cord. He accepted an operation of shortening of the lumbar spinal length as well as interbody fusion for prevention of further deterioration of his neurological condition. He underwent a surgery, which included L2/3 and L3/4 discectomies via posterolateral approach followed by the posterolateral fusion securing by the pedicle screws and plates from L2 to L4. Postoperatively, he experienced terrible deterioration of his paraparesis followed by screw failure at the level of L4. Subsequent to these complications, he had an improvement of his deteriorated paraparesis 6 months after the surgery. Instead of an unfavorable outcome in a short postoperative period, the authors decided to propose this unique surgical strategy from the pathophysiological point of view including the facts that elongation of the caudal spinal canal length associated with lumbar motion such as flexion of the spine can influence on the elongated and anchored spinal cord. Our experience can be a choice among various surgical strategies for a patient with tethered cord syndrome by a complicated and multi-operated lipoma or a lipoma with sacral agenesis which seem to be hard to detach from the caudal part of the spinal cord.