The use of decompressive segmental sublaminoplasty to treat
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Tethered cord syndrome (TCS) is an uncommon clinical and radiologic syndrome in which patients typically present with progressive back pain, lower extremity weakness and bladder dysfunction with findings of a low-lying conus medullaris at or below the L2 vertebral body and a thickened filum terminale on magnetic resonance imaging (MRI)

A 79-year-old female with insulin-dependent diabetes mellitus presented with acute-onset right leg pain without preceding trauma, in the context of 3 months of gait deterioration. Over that time, she had progressed from ambulating independently to requiring a walker. She had no history of spinal dysraphism, myelopathy, spinal surgery or previous neurologic deficit, only noting chronic intermittent lower back pain. Her leg pain had been managed conservatively with a course of steroids and gabapentin that effectively relieved the pain, though she continued to have residual right leg weakness.

On exam, she exhibited weakness in her right iliopsoas, quadriceps, anterior tibialis and extensor hallucis longus muscle groups with pathologic hyperreflexia and markedly increased right lower extremity tone. Noncontrast lumbar spine MRI revealed L4–L5 anterolisthesis and a previously undiagnosed tethered cord with her conus medullaris extending to the L5–S1 level , in addition to L3–L4 and L4–L5 central canal stenosis .

She subsequently underwent uncomplicated left L3–L4 and L4–L5 segmental sublaminoplasties for effective central canal decompression. An onlay arthrodesis was completed at those levels to promote joint fusion after decompression in the setting of L4–L5 anterolisthesis. Postoperatively, the patient had slightly improved right leg strength and was discharged to a rehabilitation facility on postoperative day one. Six weeks postoperatively, she reported near complete resolution of the radicular right leg pain and improving right leg strength.

In conclusion, this unique case demonstrates decompressive segmental sublaminoplasty as an effective treatment for multilevel lumbar spinal stenosis causing myelopathy in a patient with a previously undiagnosed tethered spinal cord, with short-term follow-up revealing improvement in her right leg pain, weakness and myelopathic symptoms

Source: https://academic.oup.com/jscr/article/2020/3/rjaa041/5811166
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