Our Summary

This research paper is about a study conducted on patients with chronic spinal cord injuries. Typically, these patients are treated with rehabilitation and care for complications like urinary tract infections, pressure sores, bone loss, and blood clots. Surgery isn’t commonly done on these patients, but this study wanted to see if it could help.

The researchers divided the patients into two groups: one did intensive rehabilitation involving weight-bearing walking training, while the other combined this rehabilitation with surgery. The surgery involved correcting any tethering of the spinal cord, restoring the flow of the fluid that surrounds the brain and spinal cord, and removing any remaining compression on the spinal cord.

The results showed that the patients who had surgery in addition to rehabilitation did better overall. They had a higher rate of improvement according to a scale used to measure spinal cord injuries, less muscle stiffness, and quicker recovery of bowel and bladder function. The combination of surgery and rehabilitation was also found to be safe.

The study found that the improvements were more common in patients with injuries to the lower part of the thoracic spine (T7-T11) than in those with injuries to the upper part (T2-T6). The researchers concluded that combining surgery with rehabilitation could be a useful treatment approach for patients with chronic spinal cord injuries.

FAQs

  1. What is the conventional treatment for patients with chronic spinal cord injury?
  2. What was the goal of the surgical intervention in the clinical trial for patients with chronic spinal cord injury?
  3. Were the surgical intervention and intensive rehabilitation safe and effective for patients with chronic spinal cord injury?

Doctor’s Tip

One helpful tip a doctor might give a patient about detethering surgery is to follow a comprehensive rehabilitation program post-surgery to optimize recovery and functional outcomes. This may include physical therapy, occupational therapy, and other interventions tailored to the individual’s specific needs and goals. It is important for patients to actively participate in their rehabilitation to maximize the benefits of the surgery and improve their quality of life.

Suitable For

Patients with chronic complete thoracic spinal cord injury who are experiencing symptoms such as spasticity, bowel and bladder dysfunction, and impaired motor function may be recommended detethering surgery in combination with intensive rehabilitation. In particular, patients with T7-T11 injuries may be more likely to experience improvement in symptoms following surgery compared to those with T2-T6 injuries. It is important to note that detethering surgery is not typically recommended for all patients with spinal cord injury, and the decision to undergo surgery should be made on a case-by-case basis after thorough evaluation by a medical professional.

Timeline

Before detethering surgery:

  • Patient with chronic spinal cord injury undergoes rehabilitation and treatment for complications such as urinary tract infection, pressure sores, osteoporosis, and deep vein thrombosis.
  • Rarely, surgery is performed on spinal cord injury in the chronic phase.
  • Limited effective treatments available for chronic spinal cord injury patients.

After detethering surgery:

  • Patient undergoes surgical intervention for spinal cord detethering, restoration of cerebrospinal fluid flow, and elimination of residual spinal cord compression.
  • Intensive rehabilitation, such as weight-bearing walking training, is combined with surgery.
  • Higher incidence of improvement in American Spinal Injury Association Impairment Scale, reduced spasticity, and faster recovery of bowel and bladder function observed in patients who underwent surgery combined with rehabilitation.
  • Surgery and rehabilitation are found to be safe.
  • Better improvement in patients with T7-T11 injuries compared to T2-T6 injuries.
  • Surgery combined with rehabilitation shows promise in the treatment of chronic spinal cord injury patients.

What to Ask Your Doctor

  1. What is detethering surgery and how does it benefit patients with chronic spinal cord injury?
  2. What are the risks and potential complications associated with detethering surgery?
  3. How long is the recovery process after detethering surgery?
  4. What type of rehabilitation or physical therapy will be necessary after detethering surgery?
  5. What are the success rates or outcomes typically seen in patients who undergo detethering surgery?
  6. Are there any alternative treatments or therapies that may be considered instead of detethering surgery?
  7. How experienced is the surgical team in performing detethering surgery for patients with chronic spinal cord injury?
  8. What is the expected timeline for scheduling and undergoing detethering surgery?
  9. Will there be any long-term effects or limitations to consider after detethering surgery?
  10. What can I do to prepare for detethering surgery and optimize my outcomes?

Reference

Authors: Zhu H, Guest JD, Dunlop S, Xie JX, Gao S, Luo Z, Springer JE, Wu W, Young W, Poon WS, Liu S, Gao H, Yu T, Wang D, Zhou L, Wu S, Zhong L, Niu F, Wang X, Liu Y, So KF, Xu XM. Journal: Neural Regen Res. 2024 Dec 1;19(12):2773-2784. doi: 10.4103/NRR.NRR-D-23-01198. Epub 2024 Jan 31. PMID: 38595294