Spinal shortening osteotomy for adult tethered cord syndrome evaluated by intraoperative ultrasonography.
Journal
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
ISSN: 1436-2023
Titre abrégé: J Orthop Sci
Pays: Japan
ID NLM: 9604934
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
22
01
2020
revised:
27
04
2020
accepted:
07
05
2020
pubmed:
25
7
2020
medline:
30
9
2021
entrez:
25
7
2020
Statut:
ppublish
Résumé
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. 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. 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. Spinal shortening should be done under somatosensory-evoked potentials, motor-evoked potentials, and intraoperative ultrasonography to obtain safe and sufficient shortening.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
Spinal shortening should be done under somatosensory-evoked potentials, motor-evoked potentials, and intraoperative ultrasonography to obtain safe and sufficient shortening.
Identifiants
pubmed: 32703626
pii: S0949-2658(20)30142-1
doi: 10.1016/j.jos.2020.05.003
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
363-368Informations de copyright
Copyright © 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest Dr. Oe and Yamato belong to a donation-funded laboratory called the “Division of Geriatric Musculoskeletal Health.” Donations to this laboratory have been received from Medtronic Sofamor Danek, Inc.; Japan Medical Dynamic Marketing, Inc.; and the Meitoku Medical Institution Jyuzen Memorial Hospital. The other authors declare no conflicts of interest.