Our Summary

This research paper examines the effects of a specific type of spinal surgery (known as posterior vertebral column subtraction osteotomy, or PVCSO) on adults suffering from tethered cord syndrome (TCS) caused by a condition called lipomyelomeningocele. TCS is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord. Lipomyelomeningocele is a type of spina bifida where a baby’s spine doesn’t form properly, and fat and nerves become trapped in a sac along the baby’s back. The patients in this study had previously tried other surgeries to treat their condition, but these attempts were unsuccessful.

The study looked at 20 adults (15 women and 5 men) who had this surgery between 2011 and 2018. The results showed that after the surgery, the majority of patients saw improvements or a complete cessation of their symptoms, including leg pain, back pain, sensory abnormalities, motor deficits, and bowel and urinary incontinence. They also showed an improvement in their disability scores. However, four patients did experience complications from the surgery, including a tear in the membrane surrounding the spinal cord, an infection in the surgical wound, a failure of the surgical equipment that required another operation, and a new sensory abnormality.

The authors concluded that PVCSO is a potentially effective surgery for adults with TCS caused by lipomyelomeningocele, especially in cases where previous surgeries have failed. This study represents the largest review of this kind of surgery for this specific patient group to date.

FAQs

  1. What is posterior vertebral column subtraction osteotomy (PVCSO) and how does it impact adults with tethered cord syndrome (TCS)?
  2. What were the main findings from the study about the effects of PVCSO surgery on adults with TCS?
  3. What complications were observed in patients who underwent PVCSO surgery in this study?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about detethering surgery is to carefully follow post-operative instructions provided by the medical team. This may include guidelines for wound care, physical activity restrictions, and follow-up appointments. It is important to communicate any new symptoms or concerns to your healthcare provider promptly to ensure the best possible outcome.

Suitable For

Patients who are typically recommended detethering surgery are those suffering from tethered cord syndrome (TCS) caused by conditions such as lipomyelomeningocele, spina bifida, or other spinal cord abnormalities. These patients may have symptoms such as leg pain, back pain, sensory abnormalities, motor deficits, and bowel and urinary incontinence. In cases where previous surgeries have failed to alleviate these symptoms, detethering surgery may be recommended as a potential treatment option. It is important for patients to consult with a neurosurgeon or spinal specialist to determine if detethering surgery is the appropriate course of action for their specific condition.

Timeline

Before detethering surgery:

  1. Patients experience symptoms of tethered cord syndrome, such as leg pain, back pain, sensory abnormalities, motor deficits, and bowel and urinary incontinence.
  2. Patients may have tried other surgeries to treat their condition, but these attempts were unsuccessful.
  3. Patients undergo evaluation and consultation with a neurosurgeon to determine if detethering surgery is the best treatment option.

After detethering surgery:

  1. Majority of patients see improvements or a complete cessation of their symptoms.
  2. Patients show an improvement in their disability scores.
  3. Some patients may experience complications from the surgery, such as a tear in the membrane surrounding the spinal cord, an infection in the surgical wound, failure of surgical equipment requiring another operation, and new sensory abnormalities.
  4. Patients undergo post-operative care and rehabilitation to aid in their recovery.
  5. Patients are monitored for long-term outcomes and potential need for further treatment or interventions.

What to Ask Your Doctor

  1. What specific symptoms or complications am I experiencing that indicate I may need detethering surgery?
  2. What are the potential risks and benefits of detethering surgery in my specific case?
  3. How long is the recovery process after detethering surgery, and what can I expect in terms of pain and limitations during this time?
  4. What is the success rate of detethering surgery for patients with my condition, particularly if I have already undergone other surgeries that were unsuccessful?
  5. Will I need any additional treatments or therapies post-surgery to manage my symptoms or prevent complications?
  6. How often will I need follow-up appointments after detethering surgery, and what signs should I look out for that may indicate a problem or complication?
  7. Are there any lifestyle changes or modifications I should make after detethering surgery to optimize my recovery and long-term health?
  8. Are there any alternative treatments or approaches to managing my condition that I should consider before proceeding with detethering surgery?
  9. How experienced is the surgical team in performing detethering surgery, and what is their success rate in similar cases?
  10. Are there any additional resources or support services available to me as I prepare for and recover from detethering surgery?

Reference

Authors: Theodore N, Cottrill E, Kalb S, Zygourakis C, Jiang B, Pennington Z, Lubelski D, Westbroek EM, Ahmed AK, Ehresman J, Sciubba DM, Witham TF, Turner JD, Groves M, Kakarla UK. Journal: Neurosurgery. 2021 Feb 16;88(3):637-647. doi: 10.1093/neuros/nyaa491. PMID: 33372221