The Operation for Tethered Cord Syndrome With a Normally Positioned Conus in Children

Patient Positioning

• Prone: The patient is positioned prone with bolsters placed horizontally at the chest and iliac crests.

Surgical Approach

• Routine exposure of spine: Standard subperiosteal dissection is carried out with monopolar cautery, and the paraspinal muscles attaching to the lumbosacral spinous processes are dissected free.

Skin incision: A schematic drawing is shown of the lumbosacral region illustrating the surgical incision used to access the S1 laminae, which are removed.

• Single level laminotomy/laminectomy: An S1 laminectomy is performed with bone rongeurs, and bone wax is applied to the bony edges. A midline, longitudinal durotomy is then performed.

Intervention

• Cut filum: Transection of the filum terminale with bipolar cautery and scissors detethers the spinal cord.

Photograph of exposed cauda equina: An intraoperative image shows the opened dura mater tented laterally with silk sutures and midline taut and enlarged filum terminale (suture running underneath). Following this exposure, the filum is simply transected and the dura mater closed in a watert

Closure

• Dural closure: The dura is closed with a monofilament stitch. The authors prefer a running 5.0 PDS suture.
• Muscle and fascial closure: Routine per surgeon preference.
• Skin: An absorbable monofilament running suture is used.
• Drains: The authors do not use drains.