Transhiatal Approach to Filum Terminale Externum Sectioning in Adult Patient With Tethered Cord Syndrome: Case Report.

BACKGROUND AND IMPORTANCE: An adult patient was referred to our department for tethered cord syndrome. A lumbar magnetic resonance imaging showed a conus medullaris at the S2 level and the caudal part of the dural sac at the S3 level. We present a minimally invasive spine surgery procedure at the hiatus level for the treatment of tethered cord syndrome by the surgical section of the filum terminale externum, which avoids bone demolition. CLINICAL PRESENTATION: A 65-yr-old Caucasian man was referred for dysesthesia and a burning sensation in his lower limbs, which was both spontaneous and triggered by contact with his clothes. He had been unable to walk for 5 mo due to severe pain and stiffness in his legs. He suffered from minimal, occasional urinary incontinence and complained about muscle cramps in the supine position that prevented him from sleeping; he was only able to sleep when sitting in a wheelchair. Informed patient consent was obtained for the procedure; no opinion was requested from the Ethics Committee. A minimally invasive transhiatal approach with the sectioning of the superficial dorsal sacrococcygeal ligament without the removal of bone tissue allows access to the sacral canal, after which it is possible to section the filum terminale externum using a microsurgical technique. CONCLUSION: After a 6-mo follow-up period, the patient no longer had dysesthesia and pain in his legs, and was able to walk, albeit just a few meters. This surgical technique has the advantage of minimally invasive spine surgery, has few complications, and avoids risk of retethering.

[Antibiotic-prophylaxis in the minimally invasive pain surgical procedures]. / Antibioticoprofilassi nelle procedure antalgiche mini-invasive.

The minimally invasive pain surgical procedures are more and more frequently used in the treatment and management of the chronic pain. The patients will often have recourse to a higher infection's risk during the proceedings for acquired general conditions (like enterotomy, skin ulcers, bladder catheter).The analysis literature doesn't produce specific treatment guidelines about antibiotic prophylaxis in pain therapy. This document, drawn up with multidisciplinary approach, correspond to rational, efficacy and functional guide about the choice and management of the antibiotic prophylaxis during the minimally invasive pain surgical procedures.