Our Summary
This research investigates a new surgical technique to treat a birth defect known as myelomeningocele (MMC), which often results in motor problems, urinary dysfunction, and fluid buildup in the brain (hydrocephalus). MMC can be repaired in the womb, but this often leads to the spinal cord becoming ’tethered’ at the site of the repair, causing further problems.
The study looked at using a graft made from amniotic membrane (the innermost layer of the placenta) during the repair to possibly reduce this tethering. The membrane was collected during the surgery, cleaned, cut to size, and placed over the repaired area before the rest of the layers were closed up.
The authors found that this amniotic membrane graft technique was safe to use in the surgery, and only one out of eight patients needed further surgery to detether the spinal cord within a 5-year follow-up period. However, the authors caution that larger studies with longer follow-up times are needed to confirm the effectiveness of this technique.
FAQs
- What is the new surgical technique proposed in this research for treating myelomeningocele?
- How is the amniotic membrane used in the procedure to prevent spinal cord tethering?
- What were the results of the study, and how reliable are they according to the authors?
Doctor’s Tip
A helpful tip a doctor might tell a patient about detethering surgery is to follow post-operative instructions carefully, including avoiding strenuous activities that could put stress on the spine and potentially cause the spinal cord to become tethered again. It is important to attend all follow-up appointments with your healthcare provider to monitor healing and address any concerns or complications that may arise. Additionally, staying active with gentle exercises recommended by your healthcare provider can help promote healing and prevent stiffness in the spine.
Suitable For
Patients who are typically recommended detethering surgery are those who have undergone repair of a myelomeningocele in the womb and subsequently develop symptoms of spinal cord tethering, such as neurological deficits, progressive scoliosis, worsening bladder and bowel function, or evidence of spinal cord injury on imaging studies. These patients may benefit from detethering surgery to release the spinal cord from scar tissue and prevent further neurological deterioration.
Timeline
Before detethering surgery, a patient with MMC may experience motor problems, urinary dysfunction, and hydrocephalus due to the spinal cord becoming tethered at the site of a previous repair. The patient may undergo repair surgery with an amniotic membrane graft to potentially reduce tethering.
After detethering surgery, the patient may experience improved motor function, urinary function, and reduced risk of hydrocephalus. In the case of the study mentioned, only one out of eight patients required further surgery to detether the spinal cord within a 5-year follow-up period. Larger studies with longer follow-up times are needed to confirm the effectiveness of the amniotic membrane graft technique.
What to Ask Your Doctor
- What is detethering surgery and how is it performed?
- What are the risks and potential complications associated with detethering surgery?
- How long is the recovery process after detethering surgery?
- What are the expected outcomes and success rates of detethering surgery?
- Are there any alternative treatments or therapies for tethered spinal cord?
- How will the use of an amniotic membrane graft during the surgery affect the outcome?
- What specific follow-up care and monitoring will be needed after detethering surgery?
- What are the long-term implications and potential complications of a tethered spinal cord if left untreated?
- How experienced is the surgical team in performing detethering surgeries?
- Are there any lifestyle changes or precautions that need to be taken after detethering surgery?
Reference
Authors: Andrews JP, Lu AY, Perry R, Lee H, Harrison M, Gupta N. Journal: Oper Neurosurg. 2025 Apr 1. doi: 10.1227/ons.0000000000001552. Online ahead of print. PMID: 40168514