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Foreign body reactions causing spinal cord tethering: a case-based update
Juan F Martínez-Lage1, Belen Ferri Niguez, María José Almagro
1Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar, 30120 Murcia, Spain. juanf.martinezlage@cablemurcia.com
Background:
Patients operated on for myelomeningocele (MMC) and lipomeningocele (LMC) can suffer from late functional worsening that, in many cases, is due to spinal cord tethering by the post-repair scarring process.
Illustrative Cases:
In this case-based update, we report two patients operated on for MMC and LMC, respectively, who presented the clinical manifestations of spinal cord tethering, which we attributed to severe foreign body reactions to the materials used at their primary back surgery. In the first case, the cause of the tethering was an intense fibrotic scar around the silk suture used at the initial MMC repair, while in the second one, it was due to a fibrotic mesh containing the lyophilized dural graft implanted for LMC surgery. After a search of the current literature, we were unable to find cases of spinal cord tethering related to excessive scarring after dural repair with foreign materials used for the surgical correction of spinal dysraphism.
Discussion And Conclusions:
The pathogenesis of spinal cord tethering in our instances closely relate with the histopathologically observed intense foreign body reaction around the materials used at the primary back surgery. We recommend avoiding as much as possible the use of foreign materials during the initial repair of spinal dysraphism.
Insights
Late functional worsening after spinal surgery for myelomeningocele (MMC) and lipomeningocele (LMC) can occur. This study highlights how foreign materials used in surgery can cause severe scarring and spinal cord tethering.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Pathology
Background:
- Patients with myelomeningocele (MMC) and lipomeningocele (LMC) may experience delayed functional decline.
- Spinal cord tethering due to scarring is a common cause of this worsening.
Observation:
- This report details two cases of spinal cord tethering.
- Tethering was attributed to foreign body reactions to surgical materials used in primary repairs.
- One case involved silk sutures, the other a fibrotic mesh with a dural graft.
Findings:
- Histopathology revealed intense foreign body reactions around implanted materials.
- These reactions led to significant fibrotic scarring and spinal cord tethering.
- No prior literature documented tethering from foreign materials in spinal dysraphism repair.
Implications:
- Foreign materials used in initial spinal dysraphism repair can trigger adverse tissue responses.
- Minimizing the use of foreign materials in primary repairs is recommended to prevent spinal cord tethering.
- This approach may improve long-term functional outcomes for patients.
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