The patient came to the clinic 12-July-2002 complaining of LBP for 2 years after falling down. On examination she was neurologically free and there was slight elevation of the mid back due to fatty hypertrophy. The patient was sent to perform MRI of the lumbar spine and done 19-February-2007 showing showing spina bifida of L2,3 and L4 with tethered cord to the dura behind of L3 body. The patient was advised to keep in conservative treatment and to be followed if any deterioration taking place.

The patient then came 23-January-2013 complaining of intrascapular pain for 45 days with occasional left hip pain. The lump in the back still the same, but there was weak dorsiflexion both feet 4/5 with hypalgesia both L5 territories.

The patient was sent for new MRI of the dorsal and lumbar spine with LSS X-rays dynamic studies, which done 23-January-2013, showing slight tightening of the tethered cord at the same L3 level.

Exposure of the dura above the defect after partial laminectomy of the deformed L3 lamina. The dissection was carried down  until circumferential exposure of the lipoma and the dural boundaries with it were seen visually. The extradural lipoma was resected off to increase the visual control of the surgery. Longitudinal incision above and below the lesion and small remnant of the dura was kept around the defective spinal cord to preserve all the running roots above and below. The dorsal rootlets were running to the upper direction, which means that the dura was severely pushed downward. The arachnoid was dissected around the spinal cord and root s to further untether the minor elements. All these elements were pushed inside the dura and the dura was water-tightly closed by 3 zero nylon. Using head up position and Valsalva maneuver, no CSF is coming out.

Routine closure of the wound. Smooth postoperative recovery. The power of the feet became normal.

The patient had clinically silent tethered cord syndrome with the spinal cord with lipoma adherent at the level of L3. It started to show deterioration in this age, which could be due to her height growth in this age. Untethering is now indicated.

For more detailed information about tethered cord syndrome, click here!