Surgical treatment of spinal cord and rootlet tethering

Spinal cord and rootlet tethering to the surrounding dura by arachnoidal scarring from any cause will alter normal spinal cord and rootlet elasticity as well as CSF flow. Such change in dynamic can lead to a progressive myelopathy with presenting symptoms of progressive sensory, motor, and functional loss, spasticity, neuropathic pain, and autonomic dysfunction. Common causes of spinal arachnoidal scarring include trauma, hemorrhage, infection, chronic stenosis, and prior spinal cord surgery. 

Spinal cord and rootlet tethering can also lead to progressive spinal cord myelomalacia and cystic cavitation (syringomyelia), as a result of tensile injury to the neural elements and alteration of CSF flow. In such cases, presenting symptoms are the same as those with progressive myelopathies caused by spinal cord and rootlet tethering alone.

We discuss our 26-year surgical experience treating progressive myelopathies from spinal cord and rootlet tethering, with or without progressive myelomalacia and cystic cavitation (syringomyelia), along with objective and subjective patient outcome.

Pre and post-surgical MR imaging, intraoperative ultrasonography video, and operative evoked potential monitoring data will be used to discuss the effects of arachnoidal scarring on the normal spinal cord dynamic within the spinal axis.