Our Summary

This study involves a 55-year-old woman who had chronic back and leg pain due to a condition called tethered cord syndrome. This condition was a result of multiple surgeries to fix a type of spina bifida (a birth defect where the spine and spinal cord don’t form properly) and a related condition called lipomyelomeningocele. The researchers used a treatment called spinal cord stimulation (SCS) on her. This treatment involves sending a mild electric current to the spinal cord to control pain.

After the treatment, the woman’s pain rating dropped significantly and she also reduced her daily use of powerful painkillers. She reported a 70%-85% reduction in her back and leg pain, improved walking ability, and better overall quality of life.

The researchers also looked at other studies and found two other cases where SCS was used to treat tethered cord syndrome. In these cases, the patients also reported similar improvements in pain relief. Thus, the study suggests that spinal cord stimulation could be a potential treatment option for patients with tethered cord syndrome.

FAQs

  1. What is spinal cord stimulation (SCS) and how is it used in treating chronic neuropathic pain?
  2. Can SCS be used in patients with tethered cord syndrome?
  3. What improvements were observed in the case of the 55-year-old woman after undergoing SCS paddle lead placement?

Doctor’s Tip

One helpful tip a doctor might tell a patient about detethering surgery is to discuss the potential benefits of spinal cord stimulation (SCS) as a treatment option for chronic neuropathic pain following the surgery. SCS has been shown to provide significant pain relief in patients with tethered cord syndrome and can improve quality of life. It is important to have a thorough discussion with your healthcare provider about all available treatment options to determine the best course of action for managing your pain after detethering surgery.

Suitable For

Patients who are typically recommended detethering surgery include those with tethered cord syndrome, which can be caused by conditions such as lipomyelomeningocele, spina bifida, or previous detethering surgeries. Symptoms of tethered cord syndrome may include chronic low back and leg pain, gait dysfunction, and neurological deficits. Patients who have failed conservative treatments for their symptoms may be candidates for detethering surgery to relieve compression on the spinal cord and improve their quality of life.

Timeline

  • Patient with history of lipo-myelomeningocele repair and multiple detethering surgeries experiences chronic low back and leg pain with progressive gait dysfunction.
  • Successful trial of spinal cord stimulation (SCS) paddle lead placement.
  • Decrease in visual analog scale for pain from 9/10 to 0-2/10 and reduction in daily opioid intake.
  • Last follow-up shows 70%-85% relief of low back and leg pain, improved ambulation, and better quality of life.
  • Literature review identifies 2 other case reports of SCS in tethered cord syndrome with similar pain alleviation.

What to Ask Your Doctor

  1. What is detethering surgery and how does it work to alleviate symptoms of tethered cord syndrome?
  2. What are the potential risks and complications associated with detethering surgery?
  3. How long is the recovery process after detethering surgery and what can I expect in terms of pain management and rehabilitation?
  4. Are there alternative treatments or therapies available for managing symptoms of tethered cord syndrome?
  5. What is the success rate of detethering surgery in improving symptoms and quality of life for patients with tethered cord syndrome?
  6. How often do patients require multiple detethering surgeries, like the case mentioned in the study?
  7. What is the role of spinal cord stimulation (SCS) in managing chronic pain associated with tethered cord syndrome, and how does it compare to other pain management options?
  8. Are there any specific guidelines or considerations for undergoing SCS after detethering surgery?
  9. What are the potential risks and benefits of combining detethering surgery with SCS for the treatment of tethered cord syndrome?
  10. What are the long-term outcomes and prognosis for patients who undergo detethering surgery and SCS for tethered cord syndrome?

Reference

Authors: Novik Y, Vassiliev D, Tomycz ND. Journal: World Neurosurg. 2019 Feb;122:278-281. doi: 10.1016/j.wneu.2018.10.215. Epub 2018 Nov 9. PMID: 30415046