A TRANSSACRAL APPROACH THROUGH THE SACRAL HIATUS USING A RIGID ENDOSCOPE. EXTRADURAL DISSECTION OF FILUM TERMINALE. CADAVER STUDY.

A TRANSSACRAL APPROACH THROUGH THE SACRAL HIATUS USING A RIGID ENDOSCOPE . EXTRADURAL DISSECTION OF FILUM TERMINALE . CADAVER STUDY

Abstract : Tethered cord syndrome (TCS ) is a stretch-induced functional dis of the

spinal cord , which is directly related to filum fixation . Classic surgical approaches to the filum involve open surgery and include varying amounts of spinal bone removal . In an effort to reduce the morbidity and mortality of these procedures , we explored a less invasive method . We evaluated the ability , safety and feasibility for extradural endoscopic dissection of the filum terminale by performing [banner_entry_middle]

upward orientated navigation in the sacral spinal canal through the sacral hiatus using a rigid endoscope . Four adult , phenol-formalin embalmed cadavers were used for extradural endoscopic dissection of the filum at the tip of thecal sac . After preparing the anatomical area of sacral hiatus , a rigid endoscope (Storz , of 3 .8 mm external diameter with one working channel ) was inserted into the sacral spinal canal and the filum was identified and cut easily . In all cases , it was possible to manipulate the rigid endoscope and inspect the full length of the extradural sacral spinal canal , especially at the S1-S2 level . Our results indicate that the tested transhiatal approach for upward orientated extradural endoscopy represents a minimally invasive procedure that provides an appropriate and feasible route to the extradural sacral spinal canal . Furthermore it is an attractive alternative for filum dissection in cases where tethered cord syndrome is not accompanied by any other pathology

Introduction

Physicians and scientists have explored the clinical usefulness of spinal endoscopy over six decades . Endoscopic spinal surgery represents a major advance in the treatment of spinal diss . It involves the use of small incisions that preserve normal tissues while allowing the spinal pathology to be fully treated . This technique carries interesting clinical benefits , and its utility continues to expand as technology advances

Tethered cord syndrome (TCS ) is a manifestation of spina bifida occulta and can occur as a complication of surgically closed spina bifida aperta . The mechanical cause of TCS is an inelastic structure anchoring the caudal end of the spinal cord and preventing cephalad movements of the lumbosacral cord . Stretching of the spinal cord occurs in patients either when the spinal column grows faster than the spinal cord or when the spinal cord undergoes forcible flexion and extension . Symptomatic TCS can occur in adults as well as in children , manifesting with various clinical symptoms (Dachling , 1982 Kaplan , 1980 Klekamp et al . 1994 such as pain , neurological deficits , and bowel and bladder dysfunction Further studies have shown that early surgical correction in adults is recommended because of the high risk for irreversible neurological deficits (Bermans et al . 2001

In recent years , further research efforts of scientists have ranged from full-fledged neurosurgery to minimally invasive approaches and have involved the use of flexible and rigid endoscopes for diagnosis and treatment of certain pathological entities (Heavner et al . 1991 Sabreski Kitahata , 1995 1996 Warnke et al . 2001 , I , II Warnke et al . 2003 . Encouraging results from the… [banner_entry_footer]