The value of postoperative MR in tethered cord: a review of 140 cases

Halevi, P. David; Udayakumaran, Suhas; Ben-Sira, Liat; Constantini, Shlomi

doi:10.1007/s00381-011-1578-7

Cited by 16 publications

(6 citation statements)

References 18 publications

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“…postoperative CT scanning was not necessary as long as the patient was extubated within an hour after surgery and his or her neurological condition was closely monitored. Moreover, authors of different studies in oncological and skull base tumor surgery, 3,14,18,22 spinal surgery, 15 and pediatric cranial reconstruction 5 have concluded that routine scanning has little clinical impact if surgery was without complications and can usually be omitted in the absence of neurological or other symptoms.…”

Section: Discussionmentioning

confidence: 99%

International practice variation in postoperative imaging of chronic subdural hematoma patients

Hulsbergen

Yan

Stopa

et al. 2019

Journal of Neurosurgery

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OBJECTIVEThe value of CT scanning after burr hole surgery in chronic subdural hematoma (CSDH) patients is unclear, and practice differs between countries. At the Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, neurosurgeons frequently order routine postoperative CT scans, while the University Medical Center Utrecht (UMCU) in the Netherlands does not have this policy. The aim of this study was to compare the use of postoperative CT scans in CSDH patients between these hospitals and to evaluate whether there are differences in clinical outcomes.METHODSThe authors collected data from both centers for 391 age- and sex-matched CSDH patients treated with burr hole surgery between January 1, 2002, and July 1, 2016, and compared the number of postoperative scans up to 6 weeks after surgery, the need for re-intervention, and postoperative neurological condition.RESULTSBWH patients were postoperatively scanned a median of 4 times (interquartile range [IQR] 2–5), whereas UMCU patients underwent a median of 0 scans (IQR 0–1, p < 0.001). There was no significant difference in the number of re-operations (20 in the BWH vs 27 in the UMCU, p = 0.34). All re-interventions were preceded by clinical decline and no recurrences were detected on scans performed on asymptomatic patients. Patients’ neurological condition was not worse in the UMCU than in the BWH (p = 0.43).CONCLUSIONSWhile BWH patients underwent more scans than UMCU patients, there were no differences in clinical outcomes. The results of this study suggest that there is little benefit to routine scanning in asymptomatic patients who have undergone surgical treatment of uncomplicated CSDH and highlight opportunities to make practice more efficient.

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Section: Discussionmentioning

confidence: 99%

International practice variation in postoperative imaging of chronic subdural hematoma patients

Hulsbergen

Yan

Stopa

et al. 2019

Journal of Neurosurgery

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“…A study of 140 cases of tethered cord consisting of 48 cases of lipomyelomeningocele demonstrated no advantage in obtaining routine postoperative follow-up MRI scans. 24 In this study, only a single reoperation was performed on lipomyelomeningocele, and that was prompted by clinical evaluation rather than imaging. Determining the need for a tethered cord release after primary repair of a lipomyelomeningocele therein remains largely a clinical decision based on neurological function rather than on radiological findings.…”

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confidence: 99%

Lipomyelomeningocele: pathology, treatment, and outcomes

Sarris

Tomei²,

Carmel³

et al. 2012

FOC

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Lipomyelomeningocele represents a rare but complex neurological disorder that may present with neurological deterioration secondary to an inherent tethered spinal cord. Radiological testing is beneficial in determining the morphology of the malformation. Specialized testing such as urodynamic studies and neurophysiological testing may be beneficial in assessing for neurological dysfunction secondary to the lipomyelomeningocele. Early surgical intervention may be beneficial in preventing further neurological decline.

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“…TCS is usually associated with heterogeneous group of spinal dysraphism, such as diastematomyelia, lipoma, thickened filum, and myelomeningocele [12]. MRI is the modality of choice for evaluation of TCS [12] as it shows structural information required to assess, classify, and identify associated pathologies, and to plan treatment.…”

Section: Discussionmentioning

confidence: 99%

“…MRI is the modality of choice for evaluation of TCS [12] as it shows structural information required to assess, classify, and identify associated pathologies, and to plan treatment. Our patients had combinations of all four pathologies.…”

Section: Discussionmentioning

confidence: 99%

Variation in Outcome in Tethered Cord Syndrome

2016

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Study DesignFifty patients surgically treated for tethered cord syndrome (TCS) were retrospectively studied at Liaquat National Hospital, Karachi from 2010 until 2014.PurposeTo assess the common presentations of TCS in our part of the world and the surgical outcome of the different presentations.Overview of LiteratureTCS is a stretch-induced functional disorder of the spinal cord with its caudal part anchored by an inelastic structure, which results in characteristic symptoms and signs. Due to the variety of lesions and clinical presentations and the absence of high-quality clinical outcome data, the decision regarding treatment is difficult.MethodsFifty consecutive patients with TCS were reviewed retrospectively with a follow-up period of 12–48 months. The majority of the patients were 0-15 years of age with the mean age of 4 years. The presenting complaints and the associated pathologies were documented, and the patients were assessed using the new Karachi TCS severity scale for clinical assessment.ResultsEighty five percent of the patients with thickened filum terminale improved. Sixty six percent of the patients with diastematomyelia, 60% with lipoma and only 46% with myelomeningocele showed clinical improvement postoperatively. Sixty two percent of the patients who presented with paraperesis improved following surgery while 37% remained stable and only one patient deteriorated. Back and leg pain improved in 93% of patients and 50% of patients with urinary impairment improved.ConclusionsOutcome of patients with TCS varies according to pathology and severity of symptoms. Diastematomyelia and thickened filum had the best outcome. The Karachi TCS severity scale is a valid tool for future studies.

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The value of postoperative MR in tethered cord: a review of 140 cases

Cited by 16 publications

References 18 publications

International practice variation in postoperative imaging of chronic subdural hematoma patients

International practice variation in postoperative imaging of chronic subdural hematoma patients

Lipomyelomeningocele: pathology, treatment, and outcomes

Variation in Outcome in Tethered Cord Syndrome

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