Our Summary

This research paper is about predicting the risk of spinal cord re-attachment or “retethering” in patients who have previously had a surgery to correct a condition like lipomyelomeningocele, a type of spina bifida. The focus is on patients who had this surgery before they were 12 months old, between 2008 and 2022.

The study involved 72 patients, of which almost 57% had lipomyelomeningocele. At the start, most of these patients (87.5%) didn’t have any symptoms. But, over an average follow-up period of about 45 months, almost 40% started showing new symptoms.

The researchers developed a machine learning model to predict which patients would start showing symptoms based on their spinopelvic parameters (measurements related to the spine and pelvis). They found that patients whose lumbosacral angle (LSA - an angle in the lower back) increased at a rate greater than or equal to 5.84 degrees per year stayed symptom-free. However, patients whose LSA increased at a slower rate started showing neurological symptoms.

In simpler terms, if the angle in the lower back changes quickly enough each year after the surgery, the patient is likely to remain symptom-free. If it doesn’t change as quickly, they are at risk of developing neurological symptoms. This is the first study to use a machine learning algorithm to predict symptom development in such patients.

FAQs

  1. What is the purpose of this research study on detethering surgery?
  2. How did the researchers use a machine learning model in this study on spinal cord re-attachment?
  3. What are the key findings of the research regarding the risk of neurological symptom development post-surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about detethering surgery is to closely monitor any changes in their lower back angle (LSA) after the procedure. If the angle is increasing at a rate of 5.84 degrees or more per year, they are less likely to experience symptoms. However, if the angle is not changing as quickly, they should be vigilant for any new neurological symptoms that may indicate spinal cord re-attachment or retethering. Regular follow-up appointments and imaging tests can help catch any issues early on.

Suitable For

Detethering surgery is typically recommended for patients who have had previous spinal cord surgeries, such as for lipomyelomeningocele, and are at risk of spinal cord re-attachment or retethering. In this study, patients who had surgery before the age of 12 months and showed an increase in lumbosacral angle at a slower rate were more likely to develop neurological symptoms.

Therefore, patients who have had previous spinal cord surgeries, especially at a young age, and are showing signs of spinal cord retethering or are at risk of developing neurological symptoms are typically recommended for detethering surgery. It is important to monitor these patients closely and consider surgical intervention if symptoms start to appear to prevent further complications.

Timeline

Before detethering surgery, a patient may experience symptoms such as back pain, leg weakness, changes in bowel or bladder function, and difficulty walking. They may also undergo imaging tests such as MRI to diagnose the condition causing these symptoms.

After detethering surgery, the patient may experience relief from their previous symptoms and improved mobility. However, there is a risk of spinal cord re-attachment or “retethering” which can lead to the return of symptoms such as pain, weakness, and changes in bowel or bladder function.

The study mentioned above suggests that monitoring the patient’s spinopelvic parameters, specifically the lumbosacral angle, can help predict the risk of retethering and the development of new neurological symptoms. By identifying patients at higher risk, healthcare providers can intervene early and potentially prevent the return of symptoms through additional surgery or other treatments.

What to Ask Your Doctor

  1. What is the purpose of detethering surgery and how does it differ from the initial surgery for my condition?

  2. What are the potential risks and complications associated with detethering surgery?

  3. How long is the recovery period after detethering surgery and what can I expect in terms of post-operative care?

  4. Will I need to undergo any additional tests or imaging studies before the surgery to determine if retethering is likely?

  5. Are there any specific factors or measurements related to my spine and pelvis that could indicate a higher risk of retethering after surgery?

  6. What is the success rate of detethering surgery for patients who have previously undergone surgery for conditions like lipomyelomeningocele?

  7. Are there any lifestyle changes or precautions I should take after detethering surgery to reduce the risk of retethering?

  8. How often will I need follow-up appointments or monitoring after detethering surgery to assess for any signs of retethering?

  9. Are there any alternative treatments or therapies that could be considered instead of detethering surgery for managing symptoms related to retethering?

  10. Can you provide me with more information about the machine learning model used in this study to predict the risk of retethering in patients who have previously undergone surgery for conditions like lipomyelomeningocele?

Reference

Authors: Punchak MA, Bond KM, Wathen CA, Hollawell ML, Zhao C, Sarris C, Flanders TM, Madsen PJ, Tucker AM, Heuer GG. Journal: J Neurosurg Pediatr. 2024 Mar 1;33(5):405-410. doi: 10.3171/2023.11.PEDS23278. Print 2024 May 1. PMID: 38428005