Foreign body reactions causing spinal cord tethering: a case-based update

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 fo...

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Bibliographic Details
Published in:Child's nervous system 2010-05, Vol.26 (5), p.601-606
Main Authors: Martínez-Lage, Juan F, Ferri Ñiguez, Belen, Almagro, María José, Rodriguez, María Cristina, Pérez-Espejo, Miguel A
Format: Article
Language:English
Subjects:
Case-Based Update
Female
Foreign-Body Reaction - complications
Humans
Infant, Newborn
Medicine
Medicine & Public Health
Meningocele - surgery
Meningomyelocele - surgery
Neural Tube Defects - etiology
Neurosciences
Neurosurgery
Neurosurgical Procedures - adverse effects
Surgical Mesh - adverse effects
Sutures - adverse effects
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Summary: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.
ISSN:0256-7040
1433-0350
DOI:10.1007/s00381-010-1119-9