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Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
Long-term outcome of neurosurgical untethering on neurosegmental motor and ambulation levels
M A G C Schoenmakers1, R H J M Gooskens, V A M Gulmans
1Department of Paediatric Physical Therapy, Room KB 02.056.0, University Medical Center, Wilhelmina Children's Hospital, PO Box 85090, 3508 AB Utrecht, The Netherlands. M.A.G.C.Schoenmakers@wkz.azu.nl
Insights
Neurosurgical untethering offers stable motor and ambulation levels for most children with tethered spinal cord syndrome. However, late deterioration can occur in myelomeningocele patients, linked to obesity and retethering.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Medicine
- Developmental Neurology
Background:
- Tethered spinal cord syndrome (TSCS) is a congenital condition requiring surgical intervention.
- Long-term outcomes regarding motor and ambulation function after untethering are crucial for pediatric neurosurgery.
- Understanding factors influencing functional decline is vital for managing TSCS.
Purpose of the Study:
- To evaluate the long-term neurosegmental motor and ambulation levels in children following neurosurgical untethering for TSCS.
- To identify predictors of functional deterioration in this pediatric population.
Main Methods:
- Retrospective analysis of 44 children with TSCS undergoing neurosurgical untethering.
- Assessment of motor and ambulation levels pre- and post-surgery (mean follow-up: 7 years).
- Categorization of spinal dysraphism types, including myelomeningocele and lipomyelomeningocele.
Main Results:
- Most patients (36/44) maintained stable motor levels; few improved (3/44) or deteriorated (5/44).
- Ambulation levels remained stable in 26/44, with deterioration in 5/44; 13 were pre-ambulatory.
- Late deterioration was observed primarily in (lipo)myelomeningocele patients, associated with obesity and retethering.
Conclusions:
- Neurosurgical untethering provides stable long-term motor and ambulation outcomes for the majority of pediatric TSCS patients.
- Obesity and retethering are significant risk factors for functional decline in myelomeningocele patients post-untethering.
- Further research into managing obesity and preventing retethering is warranted for improved long-term results.
Abstract:
The aim of this study was to determine the long-term outcome of neurosurgical untethering on neurosegmental motor level and ambulation level in children with tethered spinal cord syndrome. Forty-four children were operated on (17 males, 27 females; mean age at operation 6 years 2 months, SD 5 years). Sixteen patients had myelomeningocele, nine had lipomyelomeningocele, and 19 had other types of spinal dysraphism. Motor level and ambulation level were assessed pre- and three times postsurgery (mean duration of follow-up 7 years 1 month, SD 1 year 8 months). Deterioration of motor level was seen in five of 44 patients, 36 of 44 remained stable, while improvement was seen in three of 44 patients. Deterioration of ambulation level was seen in five of 44 patients, and remained stable in 26 of 44. Thirteen of 44 children were too young to ambulate at time of operation (< 2 years 6 months). Late deterioration of motor or ambulation level was only seen in (lipo) myelomeningocele patients. Deterioration of ambulatory status was strongly associated with obesity and retethering. Revision of the initial tethered cord release was performed in nine of 44 patients, mainly in those with lipomyelomeningocele.
