Abstract
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.
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References
Bowman RM, Mohan A, Ito J, Seibly JM, McLone DG (2009) Tethered cord release: a long-term study of 114 patients. J Neurosurg Pediatrics 3:181–187
Caldarelli M, Di Rocco C, Colosimo C Jr, Fariello G, Di Gennaro M (1995) Surgical treatment of late neurological deterioration in children with myelodysplasia. Acta Neurochir (Wien) 137:199–206
Cole JS IV, Pittman T (2005) Intradural mesh: an unusual cause of spinal cord tethering. J Neurosurg (Pediatrics 3) 102:311–313
Foy AB, Giannini C, Raffel C (2008) Allergic reaction to a bovine dural substitute following spinal cord tethering. J Neurosurg Pediatrics 1:167–169
Greene CS (1995) Tethered cord syndrome. World J Med 162:258–259
Hao I, Cruz-Almeida Y, Siqueira EB, Noremberg M, Green BA, Levi AD (2005) Postoperative fibrosis after surgical treatment of the porcine spinal cord: a comparison of dural substitutes. J Neurosurg Spine 2:50–54
Herman JM, McLone JM, Storrs BB, Dauser RC (1993) Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord. Presentation, management and outcome. Pediatr Neurosurg 19:243–249
Hudgins RJ, Gilreath CL (2004) Tethered spinal cord following repair of myelomeningocele. Neurosurg Focus 16(2):E7
Inoue HK, Kobayashi S, Ohbayashi K, Kohga H, Nakamura M (1994) Treatment and prevention of tethered and retethered spinal cord using a Gore-Tex surgical membrane. J Neurosurg 80:689–693
Malliti M, Page P, Gury C, Chomette E, Nataf F, Roux FX (2004) Comparison of deep wound infection rates using a synthetic dural substitute (Neuropatch) or pericranium graft for dural closure: a clinical review of 1 year. Neurosurgery 54:599–604
Martínez-Lage JF, Pérez-Espejo MA, Palazón JH, López Hernández F, Puerta P (2006) Autologous tissues for dural grafting in children: a report of 56 cases. Childs Nerv Syst 22:139–144
Martínez-Lage JF, Piqueras C, Poza M (2001) Lumbar canal stenosis: a cause of late neurological deterioration in patients with spina bifida. Surg Neurol 55:256–260
Martínez-Lage JF, Poza M, Sola J, Tortosa JG, Brown P, Cervenakova L et al (1994) Accidental transmission of Creutzfeldt-Jakob disease by dural cadaveric grafts. J Neurol Neurosurg Psychiatry 57:1091–1094
Martínez-Lage JF, Ruiz-Espejo Vilar A, Almagro MJ, Sánchez del Rincón I, Ros de San Pedro J, Felipe-Murcia M, Murcia García F (2007) Reanclaje medular en pacientes con mielomeningocele y lipomeningocele: la segunda operación. Neurocirugía 18:312–319
Nelson MD, Bracchi M, Naidich TP, McLone DG (1988) The natural history of repaired myelomeningocele. RadioGraphics 8:695–706
Phuong LK, Schoeberl KA, Raffel C (2002) Natural history of tethered cord in patients with meningomyelocele. Neurosurgery 50:989–995
Rossitch E Jr, Bulard DE, Oakes WJ (1987) Delayed foreign body reaction to silk sutures in pediatric neurosurgical patients. Childs Nerv Syst 3:375–378
Safdar A, Kohn LF, Narayan KK (2002) Acute foreign body reaction to synthetic dural graft (letter). Am J Med 113:529
Samuels R, McGirt MJ, Attenello FJ, Garces Ambrossi GL, Singh N, Solakoglu C et al (2009) Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty. Childs Nervous Syst 25:1085–1089
Vällfors B, Hansson HA, Svenson J (1981) Absorbable or nonabsorbable suture materials for closure of the dura mater? Neurosurgery 9:407–413
Venes JL (1985) Surgical considerations in the initial repair of meningomyelocele and the introduction of a technical modification. Neurosurgery 17:111–113
Yamada S, Zinke DE, Sanders D (1981) Pathophysiology of “tehered cord syndrome”. J Neurosurg 54:494–503
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The authors state that they do not have any financial or other type of interest in the materials, methods, or findings of this study and that they have received no funding for the production of this work.
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Martínez-Lage, J.F., Ferri Ñiguez, B., Almagro, M.J. et al. Foreign body reactions causing spinal cord tethering: a case-based update. Childs Nerv Syst 26, 601–606 (2010). https://doi.org/10.1007/s00381-010-1119-9
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DOI: https://doi.org/10.1007/s00381-010-1119-9