PREVENTION OF RECURRENT TETHERED SPINAL-CORD

One of the most problematic technical considerations in surgery for th e release of tethered spinal cord is how to prevent recurrent tetherin g. Recurrent tethering is common because the spinal canal in the baby is shallow and, therefore, postoperatively, the neural contents are in direct contact with the posterior dura. The only way to prevent a rec urrent tethered cord is to be certain that the neural elements remain free within circumferentially patent cerebrospinal fluid. We hereby de scribe a method where a curved 1.5 mm oval piece of Med-por is used to create a posterior space for the neural elements. The spinal canal is expanded posteriorly, therefore, creating an abnormally wide canal to accommodate the neural elements within subarachnoid space. This metho dology was used in 18 neonate patients, and in late tethering cases af ter myelomeningocele. Technical and theoretical considerations are dis cussed.