Medical Student The Warren Alpert Medical School of Brown University Cranston, RI, US
Introduction: Tethered cord syndrome (TCS) is a neurological condition characterized by restricted movement of the spinal cord, leading to impaired perfusion and metabolism. Common symptoms include lower back and leg pain, incontinence, and sphincter dysfunction. TCS diagnosis is guided by clinical presentation and MRI findings, often consisting of a thickened filum terminale and a low-lying conus medullaris. Surgical detethering is the primary treatment, and minimally invasive endoscopic techniques have demonstrated potential advantages, including reduced complications and faster recovery, though few cases describe the use of a working channel endoscope to identify and resect the filum terminale intrathecally.
Methods: We present a case of a 60-year-old female with a complex history of spina bifida, type II diastematomyelia, tethered cord, syrinx, myelopathy, and previous lumbar fusion. The patient presented with progressive low back pain radiating to her thighs with associated cramping. After conservative measures proved ineffective, she underwent a left-sided L3-L4 interlaminar approach for endoscopic resection of the filum terminale and spinal cord detethering. A working channel endoscope was employed to enhance visualization within the intrathecal space, facilitating accurate identification and transection of the filum terminale. The dural defect was subsequently closed with DuraGen, adipose tissue, and Tisseel.
Results: The patient tolerated the procedure without complications. Postoperatively, she reported significant improvement in bilateral lower extremity pain and cramping, allowing for discharge on postoperative day six. At two-week and six-month follow up, the patient demonstrated sustained symptom relief without recurrence or new complications.
Conclusion : This case demonstrates the efficacy of using a working channel endoscope for minimally invasive detethering in TCS, allowing for precise identification and resection of the filum terminale within the intrathecal space. This approach provides several postoperative benefits, including a shorter hospital length of stay and reduced risk of postoperative complications such as spinal fluid leakage and retethering. As endoscopic technology evolves, this technique may become increasingly utilized as a viable alternative in TCS management, offering patients a safe, effective, and less invasive treatment option.
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