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Management of multiple tethering in spinal dysraphism.

Raj Kumar1, Pallav Garg, Samir Kumar Kalra

  • 1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P., India. rajkumar@gmail.com

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|June 23, 2010
PubMed
Summary

Identifying multiple spinal cord tethering lesions is crucial for spinal dysraphism patients. More than two tethering sites significantly impact clinical presentation and surgical outcomes, necessitating a refined classification.

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Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Spinal Surgery

Background:

  • Spinal cord tethering is a primary challenge in spinal dysraphism.
  • Tethering can result from single or multiple lesions.
  • Aggressive identification and release of all tethering lesions are vital for patient benefit.

Purpose of the Study:

  • To investigate the impact of the number of tethering lesions on the clinical profile and surgical outcomes in spinal dysraphism.
  • To compare outcomes between patients with one or two tethering lesions versus those with more than two.

Main Methods:

  • A retrospective study of 160 spinal dysraphism patients who underwent surgery.
  • Patients were divided into two groups: Group A (1-2 tethering sites) and Group B (>2 tethering sites).

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  • Preoperative neurological status and surgical outcomes were analyzed and compared between groups.

    • Main Results:

    • Group A included 119 patients, and Group B included 41 patients.
    • Significant differences in preoperative neurological examination findings were observed between Group A and Group B.
    • Clinical profiles and surgical outcomes showed statistically significant differences between the two groups.

    Conclusions:

    • The number of tethering lesions is a critical factor influencing spinal dysraphism.
    • Classifying tethering based on the number of lesions is essential for predicting pre- and postoperative status.
    • The term "Spina Bifida Multiplex" is proposed for cases with over two tethering lesions.