Spinal cord transection before scoliosis correction in myelomeningocele may improve bladder function

Linthorst, Josephine I.; Veenboer, Paul W.; Dik, Pieter; Pruijs, Hans; Han, Sen; Kort, Laetitia M.O. de; Jong, Tom P.V.M. de

doi:10.1002/nau.22385

Cited by 8 publications

(3 citation statements)

References 18 publications

(24 reference statements)

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“…For slow progressive scoliosis and non-severe scoliosis, some authors stated that an early untethering procedure can prevent further progression of scoliosis [18] and can clearly relieve the symptoms of back pain and neurologic dysfunction [20]. They stated a surgical correction procedure can lead to excessive traction on the conus medullaris and spinal cord because of a degenerated thickened filum fixes the conus medullaris to he spinal canal, which increases the risk of neurologic injury and greatly increases the operative difficulty [17, 21, 22]. Complications, such as cerebrospinal fluid leakage and neurologic deterioration, are also common [23].…”

Section: Discussionmentioning

confidence: 99%

More preoperative flexibility implies adequate neural pliability for curve correction without prophylactic untethering in scoliosis patients with asymptomatic tethered spinal cord, a retrospective study

Zhou

Zhang

Guo

et al. 2017

BMC Musculoskelet Disord

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BackgroundTethered spinal cord is frequently associated with scoliosis. It is still controversial whether a prophylactic untethering is necessary before correction procedure in scoliosis patients with tethered spinal cord. In this study we determined the clinical outcome of a one-stage posterior scoliosis correction without a prophylactic untethering for treating scoliosis with an asymptomatic tethered spinal cord.MethodsSeventeen (5 males and 12 females) scoliosis patients with tethered spinal cords were retrospectively reviewed. All patients underwent a one-stage posterior scoliosis correction without preventive untethering. Parameters of radiograph were used to assess correction result. The Scoliosis Research Society (SRS)-22 questionnaire was analyzed pre- and post-operatively to evaluate the clinical outcomes. The modified Japanese Orthopaedic Association (mJOA) score was used to assess the pre- and post-operative spinal cord function.ResultsThe post-operative coronal Cobb angle was significantly decreased compared with preoperative. (23.8 ± 6.4° vs. 58.4 ± 12.6°, P < 0.01). The coronal Cobb angle was 22.4 ± 6.8° at the final follow-up evaluation. The apical vertebral translation (AVT) was also decreased significantly. (27.5 mm vs. 60.9 mm, P < 0.01). The SRS-22 total score was improved at the 1-year follow-up evaluation compared with the pre-operative SRS-22 total score (87 ± 4 vs. 70 ± 5, p < 0.05). The functional activities, pain, self-image, mental health, and surgery satisfactory scores at the final follow-up evaluation were all improved compared with the corresponding pre-operative scores, especially the self-image and mental health scores (p < 0.05). The spinal cord function was stable and there was no new neurological symptoms after scoliosis correction. No difference existed between the pre- and post-operative total mJOA score (26 ± 2 vs. 27 ± 2, p = 0.39), which including subjective symptom (p = 0.07), clinical symptom (p = 0.33), daily activities (p = 0.44) and bladder function (p = 0.67).ConclusionOne-stage posterior scoliosis correction is a safe and effective surgical procedure for scoliosis patients combined with asymptomatic tethered spinal cord who have adequate spinal cord function reserve.

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Section: Discussionmentioning

confidence: 99%

More preoperative flexibility implies adequate neural pliability for curve correction without prophylactic untethering in scoliosis patients with asymptomatic tethered spinal cord, a retrospective study

Zhou

Zhang

Guo

et al. 2017

BMC Musculoskelet Disord

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“…In the neurourological literature, Linthorst et al 8 compared the postoperative bladder function of 7 children with MMCs to that in 13 controls and found improved bladder compliance and capacity, with no deleterious effects on bladder function. Lalonde and Jarvis 7 performed urodynamic studies before and after cordotomy in conjunction with correction of kyphosis in 9 children with MMCs.…”

Section: Discussionmentioning

confidence: 99%

Distal cordectomies as treatment for lumbosacral myelomeningoceles

Albright¹,

Okechi²

2014

PED

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Object The purpose of this study was to evaluate the effect of distal cordectomies on motor function in the lower extremities of infants with lumbosacral myelomeningoceles. Methods Medical records were reviewed in 32 infants with lumbosacral myelomeningoceles who were 1 day to 7 months old, who had some lower-extremity function preoperatively, and who were treated by distal cordectomies, dividing the cord between its exit from the intact spinal canal and the neural placode. Neurological function was evaluated before and after operation by therapists who were unaware of the surgical technique. Results Neurological function was unchanged after operation in 29 of 32 cases. For the others, hip flexion, foot plantar flexion, and toe movement were lost in 1 case each. Conclusions The majority of infants treated by distal cordectomies retain preoperative motor function after operation.

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“…Some have advocated for resecting the neural placode at the time of initial closure for those patients without significant lower extremity function, and for those with significant kyphosis in whom a simultaneous restorative vertebrectomy may be undertaken [ 11 ]. Although one study noted improvements in bladder function after placode resection performed at the time of later scoliosis correction, other authors have pointed out that since the placode sometimes has underlying reflex (and occasionally voluntary) sensorimotor and/or bowel and bladder function, resecting the placode places these reflex functions at risk (for example converting a reflex bladder that can retain continence between catheterizations to a flaccid and continuously dribbling bladder) and note deterioration in approximately 8% [ 12 , 13 , 14 ]. We therefore do not generally resect the placode at the time of closure.…”

Section: Technical Reportmentioning

confidence: 99%

Myelomeningocele Closure: An Embryological Perspective

Dias¹,

Lane²

2020

Cureus

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Myelomeningoceles (MMCs) represent a localized failure of primary neurulation during the fourth week of embryonic development. There are a number of misconceptions concerning the proper identification, classification, and surgical repair of these lesions. To provide surgeons with a working knowledge of early neural embryology as it relates to MMC closure as a localized failure of primary neurulation. We review the embryology of early neural development as a means of providing neurosurgeons with a better understanding of MMC closure techniques. Early neural development predicts the anatomy of MMC and knowledge of embryology helps guide repair. Repair of MMC is enhanced by knowing early neural development.

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Spinal cord transection before scoliosis correction in myelomeningocele may improve bladder function

Cited by 8 publications

References 18 publications

More preoperative flexibility implies adequate neural pliability for curve correction without prophylactic untethering in scoliosis patients with asymptomatic tethered spinal cord, a retrospective study

More preoperative flexibility implies adequate neural pliability for curve correction without prophylactic untethering in scoliosis patients with asymptomatic tethered spinal cord, a retrospective study

Distal cordectomies as treatment for lumbosacral myelomeningoceles

Myelomeningocele Closure: An Embryological Perspective

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