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Ventral anchoring of the conus medullaris: a new surgical technique preventing the radiographic recurrence of retethering after surgery for tethered spinal cord

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Abstract

Objective

Retethering is not an unusual operation for a congenital lumbosacral dysraphic spinal lesion. The present study aimed to assess a new surgical technique for preventing retethering.

Surgical technique

After untethering the spinal cord, the pia mater or scar tissue at the caudal end of the conus medullaris is anchored to the ventral dura mater loosely using 8–0 thread, and the dura mater is closed directly. This technique is called ventral anchoring.

Results

Ventral anchoring was performed in 15 patients (aged 5 to 37 years old, average age: 12.1 years old) between 2014 and 2021. All but one patient showed improvement or stabilization of the preoperative symptoms. No complication directly related to the procedure was observed. Postoperative MRI demonstrated that the dorsal subarachnoid space was restored in 14 patients but was undetectable or absent in three patients on follow-up MRI. No patients have experienced a recurrence of the tethered cord syndrome during the follow-up period.

Conclusion

Ventral anchoring is effective for restoring the dorsal subarachnoid space after untethering the spinal cord. This preliminary study suggested that ventral anchoring has the potential to prevent the postoperative radiographic recurrence of tethered spinal cord in patients with a congenital lumbosacral dysraphic spinal lesion.

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All figures and tables were prepared for the paper and were not published before.

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Acknowledgements

We thank Mr. James Robert Valera for his editorial assistance and professional advice on the manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Kitasato University Hospital, Sagamihara, Japan

    N. Morota

  2. Department of Neurosurgery, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan

    S. Ihara & S. Kuroha

  3. Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Japan

    M. Inukai

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  1. N. Morota
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  2. S. Ihara
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  3. M. Inukai
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  4. S. Kuroha
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Contributions

Nobuhito Morota contributed to the study conception and design. Material preparation and data collection were performed by Makoto Inukai and Masae Kuroha. Material and data analysis were performed by Satoshi Ihara and Nobuhito Morota. The first draft of the manuscript was written by Nobuhito Morota, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to N. Morota.

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This paper was approved by the institutional review board of Tokyo Metropolitan Chidren’s Medical Center (2022-b51).

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Morota, N., Ihara, S., Inukai, M. et al. Ventral anchoring of the conus medullaris: a new surgical technique preventing the radiographic recurrence of retethering after surgery for tethered spinal cord. Childs Nerv Syst 39, 3147–3154 (2023). https://doi.org/10.1007/s00381-023-05972-7

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  • DOI: https://doi.org/10.1007/s00381-023-05972-7

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