Our Summary

This research paper discusses a case of a 62-year-old woman who was found to have a rare birth defect known as myelomeningocele (MMC), where the spinal cord does not properly close before birth. This condition is usually detected and treated at birth, but in this case, it was not discovered until she was an adult. The woman sought medical help after experiencing persistent back pain and an ulcer (open sore), which were found to be due to the MMC after she fell.

The research team performed surgery to repair the defect and untether the spinal cord. However, a week after the surgery, the patient had to be readmitted to the hospital due to ongoing leakage of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) and a condition called hydrocephalus, where there is excess fluid in the brain. The doctors had to drain the fluid, revise the wound, and place a shunt (a tube to help drain fluid) from the lumbar region to the abdominal cavity.

After these procedures, the woman’s back pain completely resolved and there were no further episodes of cerebrospinal fluid leakage. The researchers concluded that this case and its successful treatment can provide valuable insights for managing similar cases in the future.

FAQs

  1. What is a myelomeningocele (MMC) and how is it usually treated?
  2. What complications can arise after detethering surgery for MMC?
  3. How were the post-surgery complications managed in this particular case?

Doctor’s Tip

A helpful tip a doctor might tell a patient about detethering surgery is to closely follow post-operative instructions, including keeping the surgical site clean and dry, avoiding strenuous activities, and attending all follow-up appointments. It is also important to report any new or worsening symptoms to your healthcare provider promptly. By following these guidelines, patients can help ensure a successful recovery and optimal outcomes from detethering surgery.

Suitable For

Patients who are typically recommended for detethering surgery are those with tethered spinal cords, which can occur as a result of conditions such as myelomeningocele, spinal cord injury, spinal cord tumors, spinal cord infections, or spinal cord abnormalities present at birth. Symptoms of a tethered spinal cord may include back pain, leg weakness or numbness, difficulty walking, incontinence, scoliosis (curvature of the spine), or changes in sensation or reflexes.

Detethering surgery is usually recommended when symptoms are severe or progressing, and conservative treatments such as physical therapy, medications, or spinal cord traction have not been effective. The goal of detethering surgery is to release the spinal cord from any attachments or scar tissue that are causing it to be stretched or compressed, in order to relieve symptoms and prevent further neurological damage.

It is important for patients considering detethering surgery to undergo a thorough evaluation by a neurosurgeon or spinal surgeon, who can assess the risks and benefits of the procedure based on the individual’s specific condition and symptoms. In some cases, detethering surgery may be necessary to prevent permanent neurological deficits or complications, as in the case described above.

Timeline

Before detethering surgery:

  • Patient experiences persistent back pain and an ulcer due to myelomeningocele (MMC)
  • MMC is discovered in adulthood, leading to the need for surgery
  • Surgery is performed to repair the defect and untether the spinal cord

After detethering surgery:

  • Patient is readmitted to the hospital due to ongoing leakage of cerebrospinal fluid and hydrocephalus
  • Doctors drain fluid, revise the wound, and place a shunt from the lumbar region to the abdominal cavity
  • Back pain resolves and no further episodes of cerebrospinal fluid leakage occur
  • Successful treatment provides valuable insights for managing similar cases in the future

What to Ask Your Doctor

  1. What is the reason for recommending detethering surgery in my case?
  2. What are the potential risks and complications associated with detethering surgery?
  3. What is the success rate of detethering surgery for my condition?
  4. How long is the recovery period after detethering surgery?
  5. Will I need any additional procedures or treatments after detethering surgery?
  6. What can I expect in terms of pain management after detethering surgery?
  7. How frequently will I need follow-up appointments after detethering surgery?
  8. Are there any lifestyle changes or restrictions I need to follow post-surgery?
  9. How will detethering surgery affect my overall quality of life in the long term?
  10. Are there any alternative treatment options available for my condition besides detethering surgery?

Reference

Authors: Godzik J, Ravindra VM, Ray WZ, Eskandari R, Dailey AT. Journal: Spine J. 2015 Nov 1;15(11):e57-63. doi: 10.1016/j.spinee.2015.07.463. Epub 2015 Jul 30. PMID: 26235466