Our Summary

This research paper is about a rare medical case involving a 10-year-old boy. The boy had a condition called idiopathic scoliosis, which is an abnormal curvature of the spine. He also had a low-lying conus medullaris, which is the lower end of the spinal cord sitting lower than usual.

The boy had surgery to correct these issues. During the operation, they untethered (freed) the lower end of the spinal cord at the third lumbar vertebrae (L3). They also removed part of the vertebrae (laminectomy) from the second to third lumbar vertebrae (L2 to L3) and fixed screws in the spine from the third thoracic to the second lumbar vertebrae (T3 to L2). Additionally, they used the boy’s own rib bone from the third to the sixth ribs to graft onto the spine for better support and stability (costoplasty).

Five days after the surgery, the boy started having seizures and became very sleepy. However, he recovered two days later. It was found that he had developed a subdural hemorrhage, which is a type of bleeding in the brain. This was due to intracranial hypotension, a condition where there’s less cerebrospinal fluid (CSF) - the fluid around the brain and spinal cord - than normal. This was likely because of a leak of this fluid following the surgery.

The researchers highlight this case to show the potential serious complications that can occur after such surgeries due to CSF leaks.

FAQs

  1. What is intracranial hypotension and how can it occur?
  2. What complications can occur after a significant CSF leak?
  3. What is detethering surgery and how can it potentially lead to intracranial hypotension and subdural hemorrhage?

Doctor’s Tip

A helpful tip a doctor might tell a patient about detethering surgery is to be aware of the potential risk of CSF leak and to report any symptoms such as severe headache, nausea, vomiting, or changes in mental status immediately. It is important to follow postoperative instructions carefully and to attend all follow-up appointments to monitor for any complications.

Suitable For

Patients who may be recommended detethering surgery are those with symptoms of tethered spinal cord syndrome, such as motor and sensory deficits, bladder and bowel dysfunction, scoliosis, and foot deformities. Additionally, patients with low-lying conus medullaris or other spinal cord abnormalities may also be candidates for detethering surgery. It is important to carefully evaluate each patient’s specific condition and symptoms to determine if detethering surgery is the best course of action.

Timeline

Before detethering surgery:

  • Patient presents with symptoms related to tethered spinal cord, such as back pain, leg weakness, and difficulty walking.
  • Imaging studies, such as MRI, are conducted to confirm the diagnosis of tethered spinal cord syndrome.
  • Surgical team discusses the risks and benefits of detethering surgery with the patient and family.
  • Preoperative evaluations and preparations are done to ensure the patient is ready for surgery.

After detethering surgery:

  • Surgery is performed to release the tethered spinal cord and alleviate symptoms.
  • Patient is closely monitored in the immediate postoperative period for any complications, such as bleeding or infection.
  • Patient may experience some pain and discomfort at the surgical site, which is managed with pain medications.
  • Physical therapy is initiated to help the patient regain strength and mobility.
  • Follow-up appointments are scheduled to monitor the patient’s progress and address any concerns.
  • Patient gradually improves over time and experiences relief from symptoms related to tethered spinal cord syndrome.

What to Ask Your Doctor

  1. What is the purpose of detethering surgery and how will it benefit me?

  2. What are the potential risks and complications associated with detethering surgery, including the risk of intracranial hypotension and subdural hemorrhage?

  3. How common are complications like intracranial hypotension and subdural hemorrhage following detethering surgery?

  4. What symptoms should I watch out for after surgery that may indicate a complication such as intracranial hypotension or subdural hemorrhage?

  5. How will these complications be diagnosed and treated if they occur?

  6. Are there any specific precautions or steps that can be taken during surgery to reduce the risk of these complications?

  7. How will my recovery and rehabilitation be affected if I experience a complication like intracranial hypotension or subdural hemorrhage?

  8. Are there any alternative treatments or approaches that can be considered to reduce the risk of these complications during detethering surgery?

Reference

Authors: Bhimani R, Bhimani F, Singh P. Journal: Case Rep Med. 2018 Apr 2;2018:5061898. doi: 10.1155/2018/5061898. eCollection 2018. PMID: 29808094