Our Summary

The researchers compared the long-term outcomes of patients who had postnatal myelomeningocele closure surgery at the Children’s Hospital of Pittsburgh, with the outcomes of patients who participated in the Management of Myelomeningocele Study (MOMS) trial. Myelomeningocele is a severe form of spina bifida where the backbone and spinal canal do not close before birth.

In the MOMS trial, some patients had surgery before birth (prenatal), while others had surgery after birth (postnatal). The researchers found that patients who had surgery after birth had a higher rate of certain complications, but they also had better overall walking ability and fewer complications for both the baby and the mother compared to the MOMS trial patients.

However, they also found that the ability to walk decreased significantly with age in their group of patients. This is a concern for the long-term outcomes of the babies who had surgery before birth in the MOMS trial, especially since these babies had a high rate of spinal cord issues at early ages.

The researchers concluded that the benefits of having surgery before birth may not be as substantial as the MOMS trial suggested, and they are concerned about how long the results of the surgery will last.

FAQs

  1. What is myelomeningocele and how does it relate to the study conducted at the Children’s Hospital of Pittsburgh?
  2. How did the outcomes of postnatal surgery in the Children’s Hospital of Pittsburgh study compare to the outcomes in the MOMS trial?
  3. What concerns did researchers have about the long-term outcomes of babies who had surgery before birth in the MOMS trial?

Doctor’s Tip

One helpful tip a doctor might tell a patient about detethering surgery is to follow a rehabilitation program after the surgery to help improve mobility and prevent complications. This may include physical therapy, occupational therapy, and regular follow-up appointments with a healthcare provider to monitor progress and address any concerns. It is important for patients to be proactive in their recovery and adhere to the recommendations provided by their healthcare team for the best possible outcome.

Suitable For

Patients who are typically recommended detethering surgery are those who have tethered spinal cord syndrome, which is a condition where scar tissue or other abnormalities cause the spinal cord to become stretched or compressed. This can lead to symptoms such as back pain, weakness or numbness in the legs, difficulty walking, and loss of bowel or bladder control. Patients with a history of spinal cord injury, spinal cord tumors, or previous spinal surgeries may also be recommended for detethering surgery.

Timeline

Before detethering surgery:

  • Patient may experience symptoms such as back pain, leg weakness, bladder or bowel dysfunction, and/or numbness or tingling in the legs
  • Patient may undergo diagnostic tests such as MRI or CT scans to determine the presence of tethered spinal cord
  • Patient may try conservative treatments such as physical therapy or medication to manage symptoms

After detethering surgery:

  • Patient undergoes the surgical procedure to release the tethered spinal cord
  • Patient may experience some pain or discomfort following the surgery
  • Patient may need to stay in the hospital for a few days for monitoring and recovery
  • Patient may require physical therapy or rehabilitation to regain strength and function
  • Patient may experience improvements in symptoms such as decreased pain, improved mobility, and better bladder and bowel function

Overall, the goal of detethering surgery is to improve the patient’s quality of life and prevent further neurological deterioration. It is important for patients to follow post-operative care instructions and attend follow-up appointments to monitor their progress and address any concerns.

What to Ask Your Doctor

  1. What is detethering surgery and how does it differ from other types of spinal surgeries?
  2. What are the potential risks and complications associated with detethering surgery?
  3. How long is the recovery period after detethering surgery and what will the rehabilitation process look like?
  4. What are the expected outcomes of detethering surgery in terms of pain relief, mobility, and overall quality of life?
  5. Are there any restrictions or lifestyle changes I will need to make after the surgery?
  6. How often will I need to follow up with my doctor after the surgery?
  7. What is the success rate of detethering surgery in patients with my specific condition?
  8. Are there any alternative treatments or therapies that I should consider before opting for detethering surgery?
  9. Will I need any additional imaging tests or evaluations before the surgery?
  10. Are there any long-term concerns or considerations I should be aware of regarding detethering surgery in the future?

Reference

Authors: Weaver KJ, McDowell MM, White MD, Tempel ZJ, Zwagerman NT, Deibert CP, Bonfield CM, Johnson S, Greene S. Journal: Pediatr Neurosurg. 2021;56(3):229-238. doi: 10.1159/000515038. Epub 2021 Apr 13. PMID: 33849030