Our Summary

This research paper discusses a survey that was carried out among pediatric neurosurgeons to understand their practices related to a condition called occult spinal dysraphism (OSD). OSD is a common pediatric condition that involves the spine and is often associated with skin abnormalities. The survey wanted to understand what triggers the doctors to perform imaging tests and offer preventative surgery for this condition.

The survey responses showed that most doctors agreed on performing imaging tests for severe skin abnormalities associated with OSD. However, opinions varied greatly on whether to perform imaging tests for more common, less severe skin features associated with OSD. The type of imaging test to perform was also a matter of disagreement, with some doctors preferring ultrasound screening.

The responses also showed a lack of consensus on when to offer preventative surgery for simple spinal tethering, a type of OSD. Factors such as the level of the spinal cord and thickness of a structure in the spinal cord, called the filum terminale, influenced the doctors’ decisions.

The survey results highlight that there is a lot of uncertainty and difference of opinion among doctors about how to screen and treat OSD. This indicates a need for further research to establish clearer guidelines.

FAQs

  1. What is occult spinal dysraphism (OSD) and how is it related to skin abnormalities?
  2. What were the main findings of the survey conducted among pediatric neurosurgeons about their practices related to OSD?
  3. Why is there a need for further research regarding the screening and treatment of OSD?

Doctor’s Tip

A helpful tip a doctor might tell a patient about detethering surgery is to discuss the potential risks and benefits of the procedure thoroughly before making a decision. It is important for patients to understand the reasons for surgery, the expected outcomes, and the potential complications that may arise. Additionally, patients should feel comfortable asking questions and seeking a second opinion if needed to ensure they are making an informed decision about their care.

Suitable For

Patients who are typically recommended detethering surgery are those with severe skin abnormalities associated with occult spinal dysraphism (OSD) or simple spinal tethering. Factors such as the level of the spinal cord and thickness of the filum terminale may also influence the decision to recommend surgery for these patients. It is important for patients with OSD to undergo imaging tests to determine the severity of their condition and to assess the need for surgical intervention. The lack of consensus among pediatric neurosurgeons on when to offer preventative surgery for OSD highlights the need for further research and clearer guidelines in this area.

Timeline

Before detethering surgery, a patient may experience symptoms such as back pain, leg weakness, gait abnormalities, and bladder or bowel dysfunction. These symptoms may worsen over time and can lead to neurological deficits if left untreated. The patient may undergo imaging tests such as MRI or ultrasound to diagnose the condition and determine the extent of spinal tethering.

After detethering surgery, the patient may experience relief from their symptoms as the spinal cord is freed from the tethering. Recovery time can vary depending on the individual patient and the extent of the surgery. Physical therapy may be needed to regain strength and mobility. Follow-up appointments with the neurosurgeon will be necessary to monitor the patient’s progress and ensure that there are no complications.

Overall, detethering surgery can significantly improve the quality of life for patients with OSD by relieving symptoms and preventing further neurological damage. It is important for patients to work closely with their medical team before and after surgery to achieve the best possible outcome.

What to Ask Your Doctor

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

  1. What are the potential benefits of detethering surgery for my specific case of occult spinal dysraphism?
  2. What are the potential risks and complications associated with detethering surgery?
  3. How will detethering surgery affect my child’s mobility and quality of life?
  4. What is the success rate of detethering surgery in improving symptoms and preventing further complications?
  5. What is the recovery process like after detethering surgery, and how long does it typically take to see improvements?
  6. Are there any alternative treatments or therapies that could be considered before opting for detethering surgery?
  7. How often will follow-up appointments be needed after detethering surgery, and what kind of monitoring will be required?
  8. How experienced are you in performing detethering surgery, and what is your success rate with this procedure?
  9. Are there any specific factors in my child’s case that make detethering surgery more or less likely to be successful?
  10. Can you provide any references or resources for further information about detethering surgery and occult spinal dysraphism?

Reference

Authors: Svokos K, Batista-Silverman L, Graber SJ, O’Neill BR, Handler MH. Journal: J Neurosurg Pediatr. 2021 Sep 3;28(5):592-599. doi: 10.3171/2021.5.PEDS2126. Print 2021 Nov 1. PMID: 34479200