Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10375-10383
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10375
Thoracolumbar surgery for degenerative spine diseases complicated with tethered cord syndrome: A case report
Yue-Tian Wang, Guan-Zhang Mu, Hao-Lin Sun
Yue-Tian Wang, Guan-Zhang Mu, Hao-Lin Sun, Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
Author contributions: Wang YT and Mu GZ reviewed the literature and contributed to manuscript drafting; Wang YT analyzed and interpreted the imaging findings; Sun HL was the patient’s spine surgeon and was responsible for the revision of the manuscript; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for treatment and publication of this report.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao-Lin Sun, MD, Associate Professor, Department of Orthopedics, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China. sunhaolin@vip.163.com
Received: July 5, 2022
Peer-review started: July 5, 2022
First decision: July 14, 2022
Revised: July 21, 2022
Accepted: August 24, 2022
Article in press: August 24, 2022
Published online: October 6, 2022
Processing time: 84 Days and 1.6 Hours
Abstract
BACKGROUND

Tethered cord syndrome (TCS) secondary to split cord malformation (SCM) is rare in adulthood. There is as yet no consensus about the optimal treatment method for adult patients with SCMs and degenerative spine diseases such as lumbar stenosis, spondylolisthesis and ossification of the ligamentum flavum (OLF). The tethered cord poses a great challenge to the decompression and fusion procedures for the intraoperative stretching of the spinal cord, which might lead to deteriorated neural deficits. Here, we report on a case to add our treatment experience to the medical literature.

CASE SUMMARY

We treated a 67-year-old female patient with type II SCM suffering from lumbar disc herniation, degenerative lumbar spondylolisthesis and thoracic OLF. The patient underwent thoracolumbar spinal fusion and decompression surgery for severe lower back pain, extensive left lower limb muscle weakness and intermittent claudication. After the thoracolumbar surgery, without stretching the tethered cord, the patient achieved complete relief of pain and lower extremity weakness at final follow-up.

CONCLUSION

For adult patients with underlying TCS secondary to SCM coupled with thoracic OLF and lumbar spondylolisthesis, a thoracolumbar fusion surgery could be safe and effective with the tethered cord untreated. It is critical to design individualized surgical protocols to reduce the stretch of the low-lying spinal cord.

Keywords: Tethered cord syndrome; Split cord malformations; Ossification of ligamentum flavum; Spondylolisthesis; Thoracolumbar surgery; Case report

Core Tip: Tethered cord syndrome (TCS) secondary to split cord malformation (SCM) is rare in adulthood. We present a patient who underwent thoracolumbar surgery for thoracic ossification of the ligamentum flavum and lumbar spondylolisthesis complicated with TCS. A thoracolumbar fusion surgery could be safe and effective with the tethered cord untreated. It is critical to design individualized surgical protocols to reduce the stretch of the low-lying spinal cord. A literature review of SCM in adults was also performed.