Our Summary

Spinal dysraphism is a group of disorders caused by improper development of the spinal cord in the womb. This can lead to a strain on the spinal cord that can harm the nerves in the lower part of the spine, potentially leading to neurologic deficits. People with these disorders can experience a range of symptoms, from none at all to severe problems.

There is ongoing debate about the best time to perform surgery to release the tension on the spinal cord, but everyone agrees that the surgery should be of the highest standard. Using intraoperative neurophysiology (ION), which involves monitoring the nervous system during surgery, can help make the surgery safer by reducing the risk of accidental nerve damage. This research is particularly relevant to pediatric neurosurgery and conditions related to the development of the spinal cord and neural tube defects.

FAQs

  1. What is spinal dysraphism and what are its potential effects?
  2. What is detethering surgery and when is it typically indicated for patients with spinal dysraphism?
  3. How does intraoperative neurophysiology contribute to the safety of tethered cord surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about detethering surgery is to follow all pre-operative instructions carefully, such as fasting before the surgery and stopping certain medications as advised by the medical team. It is important to discuss any concerns or questions with the surgical team before the procedure to ensure a successful outcome. It is also important to follow post-operative care instructions closely, including any restrictions on physical activity and attending all follow-up appointments for proper monitoring of recovery.

Suitable For

Patients who are typically recommended for detethering surgery include those with spinal dysraphism, neural tube defects, and tethered cord syndrome. These patients may present with a range of symptoms, from asymptomatic to severe neurological deficits. The decision to undergo surgery and the timing of the surgery are still topics of debate, but there is consensus on the importance of providing high-quality surgical treatment. Intraoperative neurophysiological monitoring can help reduce the risk of iatrogenic neurological damage during detethering surgery.

Timeline

Before detethering surgery:

  1. Patient presents with symptoms such as back pain, lower extremity weakness, sensory changes, bowel or bladder dysfunction.
  2. Patient undergoes imaging studies such as MRI to confirm the presence of a tethered spinal cord.
  3. Neurosurgeon evaluates the patient and determines the need for detethering surgery.

After detethering surgery:

  1. Patient undergoes detethering surgery where the spinal cord is released from its tethered position.
  2. Intraoperative neurophysiology monitoring is used during surgery to ensure the safety of neurological structures.
  3. Patient is closely monitored in the hospital post-surgery for any complications.
  4. Patient undergoes rehabilitation and physical therapy to regain strength and function.
  5. Patient may experience improvements in symptoms such as pain, weakness, and bowel/bladder dysfunction.
  6. Long-term follow-up is required to monitor for any recurrence of symptoms or complications.

What to Ask Your Doctor

  1. What is the specific reason for recommending detethering surgery in my 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 physical therapy or other rehabilitation after the surgery?
  5. What are the chances of experiencing improvement in my symptoms after the surgery?
  6. How often do you perform detethering surgery, and what is your success rate?
  7. Are there any alternative treatments or procedures that could be considered instead of detethering surgery?
  8. Will I need to undergo any additional tests or imaging before the surgery?
  9. What can I expect in terms of pain management during and after the surgery?
  10. Are there any long-term effects or considerations I should be aware of following detethering surgery?

Reference

Authors: Pasquali C, Basaldella F, Sala F. Journal: Adv Tech Stand Neurosurg. 2023;47:235-272. doi: 10.1007/978-3-031-34981-2_9. PMID: 37640878