Our Summary

This study discusses the case of a 72-year-old man who suddenly began to feel weak and experienced a strange sensation in his left leg. After undergoing some scans, the doctors discovered that he had been born with an unusual defect in his spine, which included a very large myelomeningocele - a type of birth defect where the spinal cord is not fully developed and the bones in the back do not properly form.

After a meticulous surgery to untether or “free” the spinal cord, the patient was able to walk again, albeit with a little assistance. The case is unusual because not only are such spinal defects rare, but usually they are diagnosed much earlier in life. Plus, the patient responded well to a less aggressive treatment approach.

FAQs

  1. What is a microsurgical detethering of the spinal cord?
  2. What are the potential outcomes of microsurgical detethering in patients with myelomeningocele?
  3. Can microsurgical detethering of the spinal cord help improve ambulation in older patients?

Doctor’s Tip

One helpful tip a doctor might tell a patient about detethering surgery is to follow all post-operative instructions carefully, including proper wound care, physical therapy exercises, and avoiding activities that could put strain on the surgical site. It is important to attend all follow-up appointments and communicate any concerns or changes in symptoms to your healthcare provider. Additionally, maintaining a healthy lifestyle and following a proper rehabilitation plan can help optimize recovery and outcomes following detethering surgery.

Suitable For

Patients who are typically recommended detethering surgery are those who have symptoms of tethered spinal cord syndrome, such as weakness, impaired sensation, pain, and bladder or bowel dysfunction. These symptoms may be caused by a congenital malformation, such as a myelomeningocele, or acquired conditions such as spinal cord injury or scoliosis. Patients may also be recommended for detethering surgery if they have progressive neurological deficits, worsening symptoms, or if conservative management has not been effective in relieving symptoms. Detethering surgery is often recommended to prevent further neurological deterioration and to improve quality of life for the patient.

Timeline

  1. Patient experiences sudden-onset weakness and impaired sensation in left lower extremity
  2. Radiographic evaluation reveals congenital malformation with giant thoracic prevertebral myelomeningocele
  3. Patient undergoes microsurgical detethering of spinal cord
  4. Patient recovers ambulation with assistance after surgery
  5. Patient responds well to conservative management
  6. Overall, the patient experiences a significant improvement in symptoms and function after detethering surgery.

What to Ask Your Doctor

  1. What is the purpose of detethering surgery for my condition?
  2. What are the potential risks and complications associated with detethering surgery?
  3. What is the success rate of detethering surgery for my specific condition?
  4. What is the recovery process like after detethering surgery?
  5. Will I need any additional treatments or therapies after detethering surgery?
  6. How long will it take for me to see improvements in my symptoms after detethering surgery?
  7. Are there any lifestyle changes or restrictions I need to follow after detethering surgery?
  8. How often will I need follow-up appointments after detethering surgery?
  9. Are there any long-term effects or complications I should be aware of after detethering surgery?
  10. What is the expected outcome or prognosis after detethering surgery for my condition?

Reference

Authors: Choi BD, Fehnel KP, Butler WE. Journal: World Neurosurg. 2018 Jan;109:296-297. doi: 10.1016/j.wneu.2017.10.008. Epub 2017 Oct 16. PMID: 29042329