Our Summary

Spina bifida is a common birth defect that affects around 1-2 children per 1,000 live births globally. This condition can vary greatly in severity, with the level of functional ability believed to be linked to the location of the spinal lesion. While the different functional outcomes are well-known, the relationship between them, the location of the lesion, and data from intraoperative neuromonitoring (IONM) hasn’t been explored yet. Also, the possibility of preserving function beyond the visible clinical level hasn’t been studied.

To investigate these, the researchers examined data from pediatric patients with complex cases of spina bifida undergoing repeat “detethering” surgeries. They collected demographic, clinical, and radiographic data, as well as data from IONM, which includes measurements of motor responses (tcMEPs) and muscle activity (tEMG). They then compared these with the pre-operation clinical data.

They found that in all 21 cases studied, tcMEPs could be generated at or below the level of function. In some cases, these responses were lower than the level of clinical function. Similarly, tEMG responses were found at or below the level of clinical function in most cases.

These findings suggest that there is some degree of preserved neuronal connectivity below the level of clinical function in patients with complex spina bifida. This opens up the possibility of novel treatment approaches, such as using devices to stimulate these neurological pathways.

FAQs

  1. What is spina bifida and how common is it?
  2. What is detethering surgery and why is it performed on spina bifida patients?
  3. What is the significance of the study’s findings on neuronal connectivity below the level of clinical function in patients with complex spina bifida?

Doctor’s Tip

One helpful tip a doctor might give a patient about detethering surgery is to discuss the potential for preserved neuronal connectivity below the level of clinical function. This information could lead to new treatment options, such as using devices to stimulate these pathways and improve overall function. It’s important to have open communication with your healthcare team and explore all possible options for optimal outcomes.

Suitable For

Patients with complex cases of spina bifida who have undergone previous detethering surgeries and are experiencing symptoms of tethered cord syndrome are typically recommended for detethering surgery. These symptoms may include back pain, weakness or numbness in the legs, changes in bowel or bladder function, and difficulty walking. Additionally, patients with progressive neurological deficits or worsening symptoms despite conservative management may also be candidates for detethering surgery.

Timeline

Before detethering surgery:

  1. Patient is diagnosed with spina bifida, a birth defect affecting the spinal cord.
  2. Patient may experience symptoms such as weakness, numbness, or paralysis in the lower body.
  3. Patient undergoes initial surgeries or treatments to manage symptoms.
  4. Over time, the spinal cord may become tethered, leading to worsening symptoms.

After detethering surgery:

  1. Patient undergoes detethering surgery to release the spinal cord and alleviate symptoms.
  2. Intraoperative neuromonitoring (IONM) is used during surgery to measure motor responses and muscle activity.
  3. Researchers analyze data from IONM to assess neuronal connectivity below the level of clinical function.
  4. Findings suggest the possibility of preserving function beyond the visible clinical level in patients with complex spina bifida.
  5. This opens up potential new treatment approaches, such as using devices to stimulate neurological pathways and improve patient outcomes.

What to Ask Your Doctor

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

  1. What is the purpose of detethering surgery and how will it benefit me?
  2. What are the potential risks and complications associated with detethering surgery?
  3. How will I know if I am a good candidate for detethering surgery?
  4. What pre-operative tests or evaluations will be necessary before undergoing detethering surgery?
  5. What is the success rate of detethering surgery in patients with complex cases of spina bifida?
  6. Will I need any additional treatments or therapies following detethering surgery?
  7. How long is the recovery process after detethering surgery and what can I expect during this time?
  8. Are there any long-term effects or considerations I should be aware of after undergoing detethering surgery?
  9. Will I need to follow up with a specialist or have any ongoing monitoring after detethering surgery?
  10. Are there any alternative treatment options or approaches that I should consider before proceeding with detethering surgery?

Reference

Authors: McGrath M, Sivakanthan S, Durfy S, Lee A, Browd S, Hauptman JS, Ellenbogen RG, Kinney GA, Ojemann JG, Goldstein HE. Journal: J Neurosurg Pediatr. 2024 Feb 2;33(5):411-416. doi: 10.3171/2023.11.PEDS23424. Print 2024 May 1. PMID: 38306643