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Intradural view of the spinal cord and dura after three-column osteotomy: illustrative case. J Neurosurg Case Lessons 2021 Nov 08;2(19):CASE21497

Date

09/06/2022

Pubmed ID

36061976

Pubmed Central ID

PMC9435575

DOI

10.3171/CASE21497

Scopus ID

2-s2.0-85168837802 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: A three-column osteotomy results in dural buckling, which may appear concerning upon intraoperative visualization because it may appear that the neural elements may also be buckled. The authors presented an intraoperative view after intentional durotomy of the neural elements and the relaxed state of the dura after three-column osteotomy.

OBSERVATIONS: A 52-year-old woman with adult tethered cord syndrome and previous untethering presented with worsening leg pain and stiffness, urinary incontinence, and unbalanced gait. Magnetic resonance imaging demonstrated an arachnoid web at T6 and spinal cord tethering. Spinal column shortening via three-column osteotomy was performed with concomitant intradural excision of the arachnoid web. Dural buckling was observed intraoperatively after spinal column shortening. After the durotomy, the spinal cord was visualized without kinking or buckling.

LESSONS: Dural buckling after spinal column shortening of 15 mm via three-column osteotomy at T6 did not result in concomitant buckling of the underlying neural elements.

Author List

Zhao Z, Shabani S, Agarwal N, Mummaneni PV, Chou D

Author

Saman Shabani MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin