Our Summary

This study involves a surgical technique to treat unborn babies with open neural tube defects (NTDs), such as myelomeningocele or myelocele. These are serious birth defects where the spine and spinal cord don’t form properly. The technique involves operating on the fetus while it’s still in the womb, closing the defect in two layers. The procedure was successful in all five cases, and may reduce the need for surgery after birth. However, it may not be suitable for all cases, particularly if there is a large gap in the tissue or not enough tissue available. There were some complications noted, including premature rupture of the mother’s membranes. The babies were born at an average of 34 weeks, with two delivered naturally.

FAQs

  1. What is the surgical technique mentioned in the study aimed at treating?
  2. What are some potential reasons the surgical technique may not be suitable for all cases?
  3. What were some of the complications noted in the study following the surgery?

Doctor’s Tip

A doctor may advise a patient undergoing detethering surgery to follow all post-operative care instructions carefully, including any restrictions on physical activity and wound care. It is important to attend all follow-up appointments to monitor healing and address any concerns promptly. Additionally, the doctor may recommend physical therapy to help with recovery and to prevent any complications from the surgery. It is important to communicate openly with your healthcare team about any symptoms or changes you experience after the surgery.

Suitable For

Patients who may be recommended for detethering surgery typically have tethered spinal cords, which occur when the spinal cord is attached to surrounding tissues, restricting its movement. This can lead to symptoms such as back pain, weakness, numbness, and bladder or bowel dysfunction. Detethering surgery is often recommended for patients who have symptoms that are impacting their quality of life and are not responding to conservative treatments such as physical therapy or medications. Additionally, patients with spinal cord tumors, spinal cord injuries, or spinal cord abnormalities may also be candidates for detethering surgery.

Timeline

Before detethering surgery:

  1. Patient may experience symptoms such as back pain, leg weakness, numbness or tingling in the legs, difficulty walking, and loss of bladder or bowel control.
  2. Patient undergoes diagnostic tests such as MRI or CT scan to confirm the presence of a tethered spinal cord.
  3. Patient consults with a neurosurgeon to discuss the risks and benefits of detethering surgery.
  4. Patient undergoes preoperative evaluations and tests to assess their overall health and suitability for surgery.

After detethering surgery:

  1. Patient is closely monitored in the hospital for any complications or signs of infection.
  2. Patient may experience some pain and discomfort at the surgical site, which can be managed with pain medications.
  3. Patient may need to stay in the hospital for a few days to recover before being discharged.
  4. Patient will need to follow up with their neurosurgeon for postoperative care and monitoring.
  5. Patient may need physical therapy or rehabilitation to regain strength and mobility in the affected areas.
  6. Patient may experience improvements in their symptoms such as resolution of back pain, improved mobility, and restored bladder and bowel function.

What to Ask Your Doctor

  1. What is detethering surgery and how does it work?
  2. Am I a good candidate for detethering surgery?
  3. What are the potential risks and complications associated with detethering surgery?
  4. What is the success rate of detethering surgery in treating my condition?
  5. What is the recovery process like after detethering surgery?
  6. Will I need additional surgeries or treatments after detethering surgery?
  7. Are there any long-term effects or complications that I should be aware of?
  8. How experienced are you in performing detethering surgery?
  9. What alternative treatment options are available for my condition?
  10. Can you provide me with information about other patients who have undergone detethering surgery for a similar condition?

Reference

Authors: Giné C, Arévalo S, Maíz N, Rodó C, Manrique S, Poca A, Molino JA, Carreras E, López M. Journal: Ultrasound Obstet Gynecol. 2018 Oct;52(4):452-457. doi: 10.1002/uog.19104. Epub 2018 Sep 10. PMID: 29876992