Our Summary

This research paper looks at children with a spinal condition called myelomeningocele (MMC), who are more prone to developing scoliosis (a sideways curvature of the spine) and another spinal issue called spinal cord re-tethering.

Some medical centers perform a preventive procedure called untethering on children with MMC who show no symptoms before scoliosis surgery. This is done to reduce the risk of the patient’s nervous system getting worse during or after the surgery. However, the researchers wanted to find out if this preventive untethering is necessary because it might have its own risks.

The researchers studied children with MMC who were under 21 years old and were treated with or without preventive untethering before their scoliosis surgery. They divided the patients into three groups: those who had untethering at the same time as scoliosis surgery, those who had untethering within 3 months before the scoliosis surgery, and those who did not have preventive untethering.

They found that none of the patients in any group had worsened motor or sensory function 90 days after the surgery. However, those who had preventive untethering had a higher chance of infection at the surgery site, needing to go back to the operating room, needing a blood transfusion, and staying longer in the hospital.

The researchers concluded that preventive untethering does not provide any benefit to the nervous system and actually increases the risks associated with surgery in children with MMC who are having scoliosis surgery. Therefore, it might not be a necessary procedure for these children.

FAQs

  1. What is preventive untethering and why is it performed on children with MMC before scoliosis surgery?
  2. What were the findings of the research in terms of the benefits and risks of preventive untethering?
  3. Based on the research, is preventive untethering necessary for children with MMC who are having scoliosis surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about scoliosis surgery is to discuss with their healthcare team the potential benefits and risks of undergoing preventive untethering before the surgery, especially if they have a spinal condition like myelomeningocele. It is important to weigh the potential risks of the procedure against the benefits it may provide in order to make an informed decision about their treatment plan. Additionally, patients should follow their doctor’s recommendations for post-surgery care and rehabilitation to ensure a successful recovery.

Suitable For

In summary, patients with myelomeningocele who are undergoing scoliosis surgery are typically recommended to have preventive untethering. However, this study suggests that preventive untethering may not be necessary and may actually increase the risks associated with surgery. Ultimately, the decision to recommend scoliosis surgery with or without preventive untethering should be made on a case-by-case basis, taking into consideration the individual patient’s specific medical history and needs.

Timeline

  1. Patient is diagnosed with myelomeningocele (MMC) and is monitored for potential development of scoliosis.
  2. Patient undergoes preventive untethering procedure, if deemed necessary, to reduce risk of nervous system complications during scoliosis surgery.
  3. Patient undergoes scoliosis surgery either with or without preventive untethering.
  4. Patients who had preventive untethering experience higher risk of infection, need for additional surgeries, blood transfusions, and longer hospital stays.
  5. Patients in all groups show no worsened motor or sensory function 90 days after surgery.
  6. Researchers conclude that preventive untethering may not be necessary for children with MMC undergoing scoliosis surgery.

What to Ask Your Doctor

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

  1. What are the risks and benefits of having preventive untethering before scoliosis surgery?
  2. Are there any alternative treatments or approaches that can be considered instead of preventive untethering?
  3. How will having or not having preventive untethering impact my recovery and long-term outcomes after scoliosis surgery?
  4. What is the likelihood of experiencing complications, such as infection or the need for additional surgeries, with or without preventive untethering?
  5. How experienced is the surgical team in performing scoliosis surgery on patients with myelomeningocele, and what is their success rate?
  6. How will my individual medical history and current condition be taken into account when deciding whether to proceed with preventive untethering?
  7. Are there any specific post-operative care or rehabilitation strategies that should be followed to optimize my recovery after scoliosis surgery?
  8. How will my quality of life be impacted by undergoing scoliosis surgery with or without preventive untethering?
  9. Are there any ongoing research studies or clinical trials that I may be eligible to participate in to further explore the benefits and risks of preventive untethering in this context?
  10. What are the expected long-term outcomes and potential complications associated with scoliosis surgery in patients with myelomeningocele, and how can these be managed or prevented?

Reference

Authors: Goldstein HE, Shao B, Madsen PJ, Hartnett SM, Blount JP, Brockmeyer DL, Campbell RM, Conklin M, Hankinson TC, Heuer GG, Jea AH, Kennedy BC, Tuite GF, Rodriguez L, Feldstein NA, Vitale MG, Anderson RCE. Journal: Childs Nerv Syst. 2019 Nov;35(11):2187-2194. doi: 10.1007/s00381-019-04276-z. Epub 2019 Jul 2. PMID: 31267182