Our Summary

This research paper looks at the long-term effects of surgery on patients with a condition called “tethered spinal cord”. In this condition, the spinal cord is attached abnormally to the tissues around the spine, limiting its movement. The surgery, called “detethering”, is meant to free the spinal cord and reduce symptoms like pain and neurological deficits.

The researchers studied 65 patients who had undergone this surgery. They looked at patient records and conducted surveys to assess four main areas: neurological problems, bladder problems, pain, and orthopedic issues (like scoliosis). They checked on these patients at four different times: before surgery, after surgery, 4.6 years later, and 11.2 years later. They also asked about quality of life.

They found that pain improved the most after surgery, and this improvement remained stable over time. Neurological and bladder problems also remained stable or slightly improved over the long term. However, the number of patients with scoliosis (a curvature of the spine) increased significantly over the long term.

This suggests that while the surgery provides lasting benefits in terms of reducing pain and neurological and bladder problems, it does not protect against progressive scoliosis. This is particularly true for girls who had the surgery at or under the age of 12 and who also had specific types of spinal cord abnormalities. Therefore, these patients should be closely monitored for scoliosis.

FAQs

  1. What is the purpose of detethering surgery and what symptoms does it aim to reduce?
  2. What were the long-term effects of detethering surgery on patients with tethered spinal cord, according to the research?
  3. Does detethering surgery prevent the progression of scoliosis in patients with tethered spinal cord?

Doctor’s Tip

One helpful tip a doctor might tell a patient about detethering surgery is to make sure to follow up regularly with their healthcare provider to monitor for any potential development of scoliosis. Maintaining good posture and participating in regular physical therapy exercises can also help support spinal health and prevent further complications. It’s important to communicate any new or worsening symptoms to your healthcare team so they can provide appropriate care and interventions as needed.

Suitable For

Overall, patients who are typically recommended detethering surgery are those who have symptoms of pain, neurological deficits, bladder problems, and orthopedic issues related to a tethered spinal cord. These symptoms can significantly impact a patient’s quality of life and may worsen over time if left untreated. The surgery is usually recommended to free the spinal cord and improve these symptoms.

It is important for patients to undergo a thorough evaluation by a medical professional to determine if detethering surgery is the best course of action for their specific condition. Additionally, patients who undergo this surgery should be monitored closely for any potential long-term effects, such as progressive scoliosis, to ensure they receive appropriate care and treatment.

Timeline

Overall, the timeline of a patient’s experience before and after detethering surgery can be summarized as follows:

Before surgery:

  • Patients experience symptoms such as pain, neurological deficits, bladder problems, and orthopedic issues.
  • Patients undergo diagnostic tests and consultations to determine the need for surgery.

After surgery:

  • Patients experience immediate relief from pain and neurological deficits.
  • Patients are monitored closely for any complications or changes in symptoms.
  • Patients undergo rehabilitation and physical therapy to regain strength and mobility.

4.6 years later:

  • Pain and neurological deficits remain stable or continue to improve.
  • Bladder problems may also show improvement.
  • Orthopedic issues, such as scoliosis, may begin to show signs of progression.

11.2 years later:

  • Pain and neurological deficits continue to show stable improvement.
  • Bladder problems may remain stable or slightly improve.
  • Scoliosis may progress significantly, especially in patients who had surgery at a young age or with specific spinal cord abnormalities.

Overall, detethering surgery provides long-term benefits in reducing pain and neurological deficits, but may not prevent the progression of orthopedic issues such as scoliosis. Patients should be closely monitored for any changes in symptoms or complications over time.

What to Ask Your Doctor

Some questions a patient should ask their doctor about detethering surgery include:

  1. What are the potential risks and complications associated with detethering surgery?
  2. How long is the recovery process after detethering surgery, and what can I expect during this time?
  3. Will I need physical therapy or rehabilitation after surgery, and if so, for how long?
  4. How likely is it that my symptoms, such as pain and neurological deficits, will improve after surgery?
  5. Will I need follow-up appointments or additional treatments after the surgery?
  6. How will the surgery impact my daily activities and quality of life in the long term?
  7. What are the chances of developing scoliosis or other orthopedic issues after detethering surgery, and how can they be monitored and managed?
  8. Are there any restrictions or lifestyle changes I should consider after the surgery?
  9. What is the success rate of detethering surgery for patients with my specific condition and age group?
  10. Can you provide me with any resources or additional information about detethering surgery and what to expect before, during, and after the procedure?

Reference

Authors: Dulfer SE, Drost G, Lange F, Journee HL, Wapstra FH, Hoving EW. Journal: Childs Nerv Syst. 2017 Nov;33(11):1985-1995. doi: 10.1007/s00381-017-3478-y. Epub 2017 Jul 4. PMID: 28676974