Spine-Shortening Osteotomy for Recurrent Adult Tethered Cord Syndrome Exacerbated by Traumatic Kyphosis: A Case Report

Tethered cord syndrome (TCS) is a condition in which the spinal cord becomes pathologically stretched due to various congenital or acquired etiologies, leading to progressive neurological symptoms. While surgical detethering is the gold standard for pediatric patients, adult-onset recurrent TCS presents a significant surgical challenge. Reoperation carries substantial risks—including spinal cord injury, cerebrospinal fluid leakage, and a high rate of retethering—often resulting in suboptimal long-term outcomes. Recently, spine-shortening osteotomy (SSO) has emerged as an alternative technique to reduce spinal cord tension without direct manipulation of the neural elements. Here, we report a case of recurrent adult TCS associated with a lipomyelomeningocele, which was exacerbated by post-traumatic kyphosis from an L1 compression fracture. The patient was successfully treated with SSO at the L1 level. This case highlights the utility of SSO as a safe and effective alternative to conventional revision detethering, particularly in complex cases involving spinal deformity.