Tethered cord surgery to release a spinal cord that has become trapped along the vertebrae is a four to six hour procedure performed under general anesthesia to expose the area of interest and free the spinal cord. Typically a neurological surgeon performs the procedure, with a support team to monitor the patient throughout for signs of distress. The procedure is complex and carries some risks like paralysis and chronic pain, but leaving a tethered cord untreated can cause severe complications for the patient.
Patients can develop a tethered spinal cord as a result of congenital abnormalities, trauma, and spinal surgeries. In all cases, the normally flexible spinal cord is fixed in place, and cannot accommodate growth and some types of movement. Patients can start to develop wobbly gaits, lack of bladder control, and other issues because of the pressure on the spinal cord. A surgery can relieve it, allowing the patient to recover some functions.
Before a tethered cord surgery can take place, the surgeon usually requests a battery of medical imaging studies to get a detailed picture of what is going on inside the spine. This is critical for surgical planning, and can provide some information about whether the surgery will be successful. Surgeons also request blood work and urinalysis to get a complete picture of patient health and check for any issues that might complicate anesthesia. This information can also establish a baseline that may be helpful in post surgical followups.
With all the preparations for tethered cord surgery concluded, the surgeon can schedule the procedure and the patient can meet with an anesthesiologist and the surgeon to discuss anesthesia and recovery. The patient also needs to sign consent forms indicating an understanding of the surgery and what is involved. On the day of the surgery, the patient must fast, and reports to the hospital for preparation, which includes the administration of medications before the anesthesiologist induces anesthesia and the team positions the patient face down so the surgeon can access the back.
The surgeon carefully cuts through the layers of tissue and bone to access the spinal canal for tethered cord surgery. The surgeon can remove adhesions, trim away growths, and address any other issues to free the spinal cord. If it is not possible to address the tethered cord, the surgeon can cut some spinal nerve roots to limit pain and discomfort by reducing pressure around the spinal cord. Once the surgeon is done, the team can transfer the patient to recovery.
Patients in recovery from tethered cord surgery need prophylactic antibiotics to prevent infection and pain management to address the pain associated with the surgery. Usually the patient needs to lie flat initially to allow the spine to recover. Nurses and doctors perform periodic neurological assessments to check for spinal cord injuries and complications. As the patient heals, activity levels can increase, until the patient can return to normal activities.
