Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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19-AUGUST-2013 GAHADA FALAH BUSHNAQ 21 YEARS STILL
TETHERED CORD AT l4-5 LEVEL.
The patient was operated elsewhere in Kuwait for
tethered cord with lipoma at L4-5 level in 1999.
There surgery as the mother telling complicate
with gross neurologic deterioration and CSF leak
from the wound for several weeks. MRI lumbar
spine performed 16-February-2006 showed
tethering of the spinal cord at the same level.
She underwent right hip fixation 2010.
On examination the patient is using pumpers for
urination, feeling defecation with cauda equina
syndrome, complete flail left foot 0/5 dorsi and
planterflexion and dorsiflexion right foot
1/5 and planterflexion right foot 0/5.
Talepis valgus deformity both feet more severe
in the left. Weak abduction of the knees 4/5.
Analgesia above the right knee and below the
left knee. There are atrophic ulcers right foot.
The patient did not deteriorate the last 4-5
New MRI lumbar spine done 13-August-2013 showing
the spinal cord still tethered at L4-5 level.
Laminectomy L3 with
exposure of the dura down to L5 lamina. From the
scar, it is clear that the intradural part of
the previous surgery, was performed far
inferior. The dura was opened from the most
caudal point down to circumscribe the involved
dura with the spinal cord until the running
roots below the tethered cord were seen and
preserved in the left side. Dissection of the
arachnoid around the roots and spinal cord to
eliminate all the tethering components. Using
lyodura the dural defect was water-tightly
closed. Check for CSF leak was done with
elevation of the head and Valsalva maneuver,
which ruled out CSF leak. Routine closure of the
wound with removal of the lipoma and repair of
the skin to have more acceptable cosmetic look.
It seems that in the first surgery, the tethered
cord was ignored. Untethering was the main aim
of this surgery.
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