Our Summary

This research paper is about how to improve the screening process for a condition called Tethered Cord Syndrome (TCS) in infants who have esophageal atresia and/or tracheoesophageal fistula (EA/TEF). These are birth defects affecting the esophagus and trachea.

The study looked at the medical records of 79 patients with these conditions over a 6-year period. They found that TCS was screened using MRI 58% of the time and ultrasound only 15% of the time. However, 38% of patients did not receive any screening at all.

The researchers found that TCS was detected more often using MRI than ultrasound. In fact, 73.7% of patients who had TCS detected on an MRI ended up needing neurosurgery. Of those who were screened using ultrasound, 2 had TCS and also required surgery.

Interestingly, patients with more than three VACTERL (a term referring to a group of birth defects) or vertebral anomalies were more likely to have TCS detected on an MRI. Additionally, in two cases, ultrasound failed to detect TCS in patients with vertebral anomalies, suggesting that MRI might be a superior screening method in these cases.

The researchers conclude that there needs to be an improvement in the process, as a significant number of children did not receive any kind of imaging scan.

FAQs

  1. What is the main focus of this research paper about detethering surgery?
  2. What screening methods were used to detect Tethered Cord Syndrome (TCS) in the study and how effective were they?
  3. What conclusions did the researchers draw from the study about the screening process for TCS in infants with esophageal atresia and/or tracheoesophageal fistula (EA/TEF)?

Doctor’s Tip

A helpful tip a doctor might give to a patient undergoing detethering surgery is to follow all pre-operative instructions carefully, including any fasting guidelines and medication instructions. It is important to discuss any concerns or questions with your healthcare team before the surgery to ensure the best possible outcome. After surgery, it is important to follow post-operative care instructions closely to promote healing and prevent complications. Rehabilitation and physical therapy may also be recommended to aid in recovery and improve mobility.

Suitable For

Patients who are typically recommended detethering surgery are those who have been diagnosed with Tethered Cord Syndrome (TCS) through imaging scans such as MRI. In particular, patients with more than three VACTERL or vertebral anomalies, or those who have symptoms of TCS such as back pain, leg weakness, or bladder dysfunction, may be recommended for surgery. It is important for healthcare providers to properly screen and diagnose TCS in patients with conditions such as EA/TEF to ensure timely treatment and prevent potential complications.

Timeline

Timeline before detethering surgery:

  • Patient is born with esophageal atresia and/or tracheoesophageal fistula
  • Screening for Tethered Cord Syndrome (TCS) is not always conducted, and if done, is more likely to be done using MRI rather than ultrasound
  • Patients with more than three VACTERL or vertebral anomalies are more likely to have TCS detected on an MRI
  • In some cases, ultrasound fails to detect TCS in patients with vertebral anomalies

Timeline after detethering surgery:

  • TCS is detected and confirmed through MRI or ultrasound
  • Patients undergo neurosurgery to address the TCS
  • Patients with successful surgery experience relief from symptoms such as back pain, bladder dysfunction, and leg weakness
  • Patients may require post-operative care and rehabilitation to recover fully from surgery

What to Ask Your Doctor

  1. What is Tethered Cord Syndrome (TCS) and how does it relate to my condition of esophageal atresia and/or tracheoesophageal fistula (EA/TEF)?
  2. What are the symptoms of TCS and how will it affect my health if left untreated?
  3. Why is MRI considered a superior screening method for detecting TCS compared to ultrasound?
  4. What are the risks and benefits of detethering surgery for TCS?
  5. How will detethering surgery improve my symptoms and overall health?
  6. What is the success rate of detethering surgery for TCS?
  7. What is the recovery process like after detethering surgery?
  8. Are there any long-term complications or risks associated with detethering surgery?
  9. Are there any alternative treatments or therapies for TCS that I should consider?
  10. How often will I need to follow up with you after detethering surgery?

Reference

Authors: Cowley N, Maheshwari M, Lerner DG, Lew S, Lal D, Knezevich M, Lingongo M, Gourlay D. Journal: J Surg Res. 2022 Nov;279:193-199. doi: 10.1016/j.jss.2022.06.004. Epub 2022 Jun 29. PMID: 35779449