Our Summary

This study looked at how to best treat people born with scoliosis (a curve in the spine) who also have a condition called split cord malformation (SCM), where the spinal cord is split into two parts. The goal is to correct the spine without causing any damage to the nerves.

The research was done between 2000 and 2013, with 214 patients who had both conditions and were having surgery to straighten their spines. They split the patients into two groups based on the type of SCM they had. They wanted to see if there were any differences between the two groups in terms of surgery time, blood loss, and how much of the spine they had to fix.

They found that the type of SCM didn’t really affect these factors. However, they did find that the spine was straighter after surgery in the second group compared to the first.

Some patients (about 5%) had temporary nerve problems after surgery, but this didn’t depend on the type of SCM. Importantly, no one had permanent nerve damage from the surgery.

The conclusion was that it’s safe and effective to do this kind of surgery on patients with scoliosis and SCM, without needing to do anything to the nerves beforehand. This is good news for people with these conditions, as it simplifies the treatment process.

FAQs

  1. What is the goal of detethering surgery in patients with scoliosis and split cord malformation (SCM)?
  2. Did the type of SCM affect the outcomes of the surgery such as surgery time, blood loss, and how much of the spine they had to fix?
  3. Were any complications, such as nerve damage, observed after the surgery?

Doctor’s Tip

A helpful tip a doctor might give a patient about detethering surgery is to ensure they follow all pre-operative instructions given by their healthcare provider, including fasting before surgery and stopping certain medications. It is also important to discuss any concerns or questions with the surgical team before the procedure. Additionally, following post-operative care instructions, such as taking prescribed medications, attending follow-up appointments, and participating in physical therapy, can help ensure a successful recovery.

Suitable For

Patients who are typically recommended detethering surgery are those with split cord malformation (SCM) in addition to scoliosis. This surgery is done to correct the spine without causing damage to the nerves. The study mentioned above found that the type of SCM did not affect the outcome of the surgery, and that it was safe and effective in straightening the spine without causing permanent nerve damage. It is important for patients with scoliosis and SCM to consult with their healthcare provider to determine if detethering surgery is the best course of treatment for them.

Timeline

  • Before surgery: Patients with scoliosis and split cord malformation (SCM) undergo diagnostic tests and consultations with their medical team to determine the best course of action. They may experience symptoms such as back pain, numbness or weakness in the legs, and difficulty walking.

  • Day of surgery: Patients are admitted to the hospital and undergo detethering surgery to correct the spinal deformity. The surgery typically lasts several hours and involves realigning the spine and detaching any tethered spinal cord.

  • After surgery: Patients are closely monitored in the hospital for a few days to ensure proper healing and to manage any post-operative pain. Physical therapy may be recommended to help strengthen the muscles around the spine and improve mobility.

  • Weeks to months post-surgery: Patients continue with physical therapy and follow-up appointments with their medical team to monitor their progress and address any concerns. They may gradually resume normal activities as they recover.

  • Long-term: Patients may experience improvements in symptoms such as back pain, leg weakness, and difficulty walking as their spine straightens and the spinal cord is no longer tethered. Regular follow-up appointments are important to monitor the spine and overall health.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with detethering surgery for scoliosis and split cord malformation?

  2. How long is the recovery process expected to be after detethering surgery?

  3. Will physical therapy be necessary after detethering surgery, and if so, for how long?

  4. What are the long-term outcomes and success rates for patients who undergo detethering surgery for scoliosis and split cord malformation?

  5. How often will follow-up appointments be needed after detethering surgery, and what will be monitored during these appointments?

  6. Are there any specific restrictions or limitations that I should be aware of after detethering surgery?

  7. Are there any alternative treatment options to consider for scoliosis and split cord malformation, and how do they compare to detethering surgery?

  8. How experienced is the surgical team in performing detethering surgery for scoliosis and split cord malformation?

  9. Will I need any additional imaging or tests before undergoing detethering surgery?

  10. Are there any lifestyle changes or modifications that I should make before or after detethering surgery to optimize the outcome?

Reference

Authors: Shen J, Zhang J, Feng F, Wang Y, Qiu G, Li Z. Journal: J Bone Joint Surg Am. 2016 Jun 1;98(11):926-36. doi: 10.2106/JBJS.15.00882. PMID: 27252437