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The patient was operated
06-April-2002
for extremely small posterior fossa with Arnold Chiari
malformation and did relatively well, until the last several months,
the dyspnoea attacks increased when bending the neck and the gait
started to deteriorate.
MRI of the cervico-medullary junction with cervical X-rays showed
no considerable changes. MRI of the lumbar spine showed tethered
cord. The patient still incontinent and difficult gait. with weak
left lower limb.
The patient was operated and laminectomy of L5 S1-2 was
performed. The functional spinal cord was extending down to the end
of the cul-de-sac with massive arachnoidal adhesions. With the aid of electrophysiological monitoring and microscopic
facilities, all the neural elements were identified and the spinal
cord at its attachment to the most caudal point of the cul-de-sac,
immediately after giving the last roots from both sides, it was
detached from the dura, after what it jumped 10 mm above the level.
Further neurolysis and bisecting the tethering secondary bands, it
could achieve further 10 mm after what the inverted root direction
regained relaxed normal course.
Water-tight closure of the dura.
Smooth postoperative recovery.
For theoretical data concerning tethered cord syndrome,
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