====== Spinal cord untethering ======

[[Spinal cord]] [[untethering]] by sectioning the [[filum terminale]] is commonly performed in [[tethered cord syndrome]] patients with minor abnormalities such as filar lipoma, thickened [[filum terminale]], and low conus medullaris. 

The endoscopic surgical technique, using the interlaminar approach, allows for sectioning the filum terminale through a very small skin incision. To our knowledge, this procedure has not been previously reported. This is the first case report involving a 1 cm skin incision.

Case presentation: A 9-month-old male patient was referred to our neurosurgical department due to a coccygeal dimple. MRI revealed a thickened fatty filum. After considering the treatment options for this patient, the parents agreed to spinal cord untethering. A midline 1 cm skin incision was made at the L4/5 vertebral level. Untethering by sectioning the filum terminale was performed by full endoscopic surgery using the interlaminar approach. The procedure was uneventful and there were no postoperative complications.

Conclusions: In terms of visibility and minimizing invasiveness, our surgical technique of using the interlaminar approach with endoscopy allows for untethering by sectioning the filum terminale through a very small skin incision
((Ishisaka E, Tahara S, Tsukiyama A, Nozaki T, Hattori Y, Morita A, Murai Y. Endoscopic spinal cord untethering using a 1 cm skin incision technique in pediatrics: a technical case report. BMC Pediatr. 2023 Nov 29;23(1):604. doi: 10.1186/s12887-023-04390-7. PMID: 38031015; PMCID: PMC10685644.))