Our Summary

This research paper revolves around a unique case of an 11-month-old boy who underwent a particular type of surgery for a spinal condition called lumbar lipomyelomeningocele, which is often associated with tethered cord syndrome. This surgery has its risks, including potential wound infections and leaks of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord), but these usually just affect the surgical area.

However, in this case, the boy developed a rare and dangerous infection in the brain called a subdural empyema after his surgery. Despite receiving broad-spectrum antibiotics early on, he needed further surgical revisions and an external drainage system due to persistent leaking from his wound. The infection was discovered because the boy remained highly irritable, prompting doctors to perform an MRI scan of his brain.

The boy was treated for the empyema, and his wound continued to heal well. After completing a 6-week course of antibiotics, subsequent check-ups showed no signs of the infection returning.

The paper concludes that, in rare instances, this type of brain infection can occur even after the initiation of antibiotics following surgery for lumbar lipomyelomeningocele. The infection may start at the surgical site and then spread to the brain, leading to meningitis and subdural empyema. This suggests that doctors should consider conducting brain scans if a patient shows signs of persistent discomfort following this surgery, as an undiagnosed brain infection could have severe consequences.

FAQs

  1. What is lumbar lipomyelomeningocele and how is it associated with tethered cord syndrome?
  2. What are the potential risks of surgery for lumbar lipomyelomeningocele?
  3. Why should doctors consider conducting brain scans after this surgery?

Doctor’s Tip

Therefore, a helpful tip a doctor might tell a patient about detethering surgery is to closely monitor for any signs of infection, such as persistent discomfort, redness, swelling, or drainage from the surgical site. It is important to seek medical attention promptly if any concerning symptoms develop, as early detection and treatment of an infection can prevent serious complications. Additionally, following post-operative care instructions, including proper wound care and completing any prescribed antibiotics, is crucial for a successful recovery.

Suitable For

Patients who are typically recommended detethering surgery are those who have tethered cord syndrome, a condition where the spinal cord is abnormally attached to the surrounding tissues, causing tension and limiting its movement. This condition can occur due to various reasons, such as spinal cord injuries, spinal cord tumors, or congenital abnormalities.

Patients with symptoms of tethered cord syndrome may experience back pain, leg weakness, difficulty walking, urinary or bowel incontinence, or changes in sensation. These symptoms can worsen over time, leading to significant disability if left untreated.

Detethering surgery is often recommended for patients with symptomatic tethered cord syndrome to release the tension on the spinal cord and improve symptoms. The surgery involves freeing the spinal cord from the surrounding tissues and repositioning it to allow for normal movement.

In the case discussed in the research paper, the patient had lumbar lipomyelomeningocele, a type of spinal cord defect where fatty tissue and meninges (the protective membranes surrounding the spinal cord) protrude through a defect in the spine. This condition is often associated with tethered cord syndrome and may require detethering surgery to prevent further complications.

Overall, patients with symptomatic tethered cord syndrome, especially those with associated spinal cord defects like lipomyelomeningocele, may be recommended detethering surgery to alleviate symptoms and prevent complications. However, as highlighted in the research paper, there are potential risks associated with the surgery, including rare but serious complications like brain infections, which should be carefully monitored and managed by healthcare providers.

Timeline

  • Before surgery: The patient likely experiences symptoms of tethered cord syndrome, such as lower back pain, leg weakness, urinary incontinence, and foot deformities. These symptoms may worsen over time and prompt the need for surgery.
  • Day of surgery: The patient undergoes detethering surgery to release the spinal cord from abnormal attachments and correct the underlying condition causing tethered cord syndrome.
  • Post-surgery: The patient may experience pain, swelling, and discomfort at the surgical site. They may also need to stay in the hospital for monitoring and pain management.
  • Weeks following surgery: The patient continues to recover, with regular follow-up appointments to monitor their progress and address any concerns.
  • Rare complication: In some cases, like the one described in the research paper, the patient may develop a rare complication such as a subdural empyema, which requires additional treatment and monitoring.
  • Continued recovery: The patient completes a course of antibiotics and undergoes further treatment if necessary to address any complications. Follow-up appointments continue to ensure the patient’s recovery and overall well-being.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with detethering surgery for my specific condition?

  2. How common is it for patients to develop infections like subdural empyema after detethering surgery?

  3. What symptoms should I watch out for that may indicate a post-surgical infection in the brain?

  4. How will you monitor me for signs of infection following the surgery?

  5. What steps will be taken to prevent infections during and after the surgery?

  6. How will infections be treated if they do occur after the surgery?

  7. Are there any specific factors in my case that may increase my risk of developing a post-surgical infection in the brain?

  8. How long is the typical recovery period after detethering surgery, and what signs should I look for to ensure that my recovery is progressing normally?

  9. Are there any additional precautions or measures I should take to reduce the risk of infection during my recovery period?

  10. What is the follow-up plan after the surgery to monitor for any potential complications or infections?

Reference

Authors: Nguyen HS, Foy A, Havens P. Journal: Surg Neurol Int. 2016 May 13;7(Suppl 12):S301-4. doi: 10.4103/2152-7806.182388. eCollection 2016. PMID: 27274400