Our Summary

This research paper discusses the case of a two-year-old boy who was born with a curved spine (congenital scoliosis) and a condition where the membranes that cover the brain and spinal cord protrude through a defect in the spine (anterolateral thoracic meningocele). He could walk and run, but his parents noticed weakness in his left leg and a frequent cough. The child seemed neurologically normal when examined.

An MRI scan of his spine showed that his upper spine was curved to the left and he had a meningocele that was pushing his spinal cord to the right. The surgeons decided to operate to free the spinal cord from where it was stuck and to repair the meningocele and the curved spine all at the same time.

During the surgery, they found that the bulging tissue was actually a part of the spinal cord that had split away and ended in a dead end. They tested this split cord and found it wasn’t working, so they removed it. They then freed up the main spinal cord, repaired the meningocele and closed everything up.

The boy was stable after the surgery, but it’s too early to know what the long-term results will be. The study used a lot of technical terms related to these conditions, like “myelomeningocele”, “spinal dysraphism”, and “split cord malformation”, among others.

FAQs

  1. What is detethering surgery and when is it performed?
  2. What is a meningocele and how is it related to congenital scoliosis?
  3. What were the post-surgery results and what is the expected long-term outcome?

Doctor’s Tip

A helpful tip a doctor might tell a patient about detethering surgery is to follow postoperative instructions carefully, including avoiding heavy lifting and strenuous activity to allow for proper healing of the spinal cord. It is also important to attend all follow-up appointments to monitor recovery and address any concerns or complications that may arise. Additionally, physical therapy may be recommended to help improve strength and mobility after surgery.

Suitable For

Patients who are typically recommended for detethering surgery are those with tethered spinal cords, which can occur in patients with conditions such as spina bifida, myelomeningocele, split cord malformation, and thoracic meningocele. Symptoms of tethered spinal cords can include back pain, leg weakness, bowel and bladder dysfunction, scoliosis, and neurological deficits. Patients may also present with signs of spinal cord compression, such as a frequent cough or difficulty walking. In cases where conservative management is not effective, detethering surgery may be recommended to release the spinal cord and prevent further neurological deficits.

Timeline

Before detethering surgery:

  • Patient has a history of congenital scoliosis and anterolateral thoracic meningocele
  • Presents with left leg weakness and frequent cough
  • Normal neurological examination findings
  • MRI of the spine shows congenital scoliosis and anterolateral meningocele with spinal cord tethering

After detethering surgery:

  • Neurosurgical cord detethering and repair of the meningocele performed simultaneously with scoliosis repair
  • Split cord found during dissection, determined to be nonfunctional and subsequently dissected
  • Detethering of the spinal cord followed by repair of the dural outpouching and dural closure
  • Patient stable post-surgery, long-term results still to be seen.

What to Ask Your Doctor

  1. What is the purpose of detethering surgery in my specific case?
  2. What are the potential risks and complications associated with detethering surgery?
  3. How long is the recovery process expected to be after detethering surgery?
  4. Will I need any additional treatments or therapies following detethering surgery?
  5. What is the success rate of detethering surgery in cases like mine?
  6. Will detethering surgery improve my symptoms, such as leg weakness and cough?
  7. Are there any lifestyle changes or restrictions I will need to follow after detethering surgery?
  8. How frequently will I need follow-up appointments after detethering surgery?
  9. Are there any alternative treatments or therapies for my condition besides detethering surgery?
  10. Can you provide me with more information about the specific surgical techniques and tools that will be used during detethering surgery?

Reference

Authors: Ran J, Karamian P, Robinow Z, Lui F, Gonda D. Journal: Cureus. 2023 Oct 4;15(10):e46496. doi: 10.7759/cureus.46496. eCollection 2023 Oct. PMID: 37927626