Untethering Spinal Cord Treatment Cost in India

What Are the Treatment options available for Untethered Spinal Cord?

Within the spinal canal, a normal spinal cord hangs and moves freely up and down as it grows, bends, and stretches. Because it is attached to the spinal column, a tethered spinal cord is unable to move. It is pulled tightly near the end, and the stretching and decreasing blood flow may cause damage to the spinal cord. A lumbar laminectomy (surgery) to free the tethered cord is the most common treatment for the tethered spinal cord in India. The following is a typical treatment strategy for a tethered spinal cord:

Neuromonitoring

During surgery, neurosurgeons use advanced neuromonitoring. This allows them to keep an eye on your child’s nerves and muscles in the lower body. It aids neurosurgeons in avoiding future nerve damage in your child.

Laminectomy

Neurosurgeons perform a surgery known as a laminectomy to release the spinal cord. They take out one or more sections of the spine’s bones (vertebrae). They may now access the spinal cord, spinal nerve roots, and the thecal sac that surrounds the spinal cord.

The spinal cord is then gently sliced or teased away from the scar tissue or fat by the neurosurgeons. During surgery, neurosurgeons utilize a microscope to help them visualize the area. After the spinal cord has been released, neurosurgeons may put a patch on the spinal cord’s covering (dura mater). This reduces the risk of cerebrospinal fluid (CSF) leakage.

Other Surgery

Untethering is usually done only if there are clinical signs or symptoms of deterioration. The procedure entails opening the scar from the previous closure all the way down to the dura that covers the myelomeningocele. To gain better exposure or decompress the spinal cord, a small portion of the bony vertebrae (laminae) is sometimes removed. The dura is then gradually peeled away from the scarred attachments to the surrounding dura, exposing the spinal cord and myelomeningocele. The dura and the incision are closed once the myelomeningocele is free of all scarred attachments.

Within a few weeks, the child should be able to resume normal activities. The extent and duration of preoperative effects determine the recovery of impaired muscle and bladder function. This operation has a cumulative complication rate of 1-2 %. Infection, hemorrhage, and injury to the spinal cord or myelomeningocele, which can result in diminished muscle strength, bladder or bowel function, are all possible complications. Many children only need to be untethered once. Because tethering symptoms might develop during phases of growth, 10-20% of children with this disease require multiple surgeries.

How Surgery for Tethered Spinal Cord is Performed?

Tethering Surgery of Spinal Cord in India involves the following steps:

• Needles are inserted into the lower body to monitor nerve function even as the child is asleep.
• Over the lower back, an incision is created in the skin.
• The bone is raised above the tethered portion of the spinal cord ( Laminoplasty)
• Making a small incision in the dura mater, which protects the spinal cord.
• Tethering lesion release can be simple or difficult, taking many hours of dissection under the microscope. Occasionally, surgeons will use a laser to slice tissue away from nerves.
• The dura or available tissue is closed over the spinal fluid.
• Putting the bone back in place and securing it (laminoplasty)
• Muscle and skin closure
• Putting on a bandage

Surgery for a tethered spinal cord can avoid permanent nerve damage in the future, which can have a significant impact on a child’s bladder and leg function, as well as their quality of life.

Re-operation for Tethered Cord

Following surgery, a follow-up MRI is generally conducted. A re-tether for certain types of tethered cords can occur years after the original surgery, producing radiating leg pain, persistent back pain, or bladder difficulties. This scenario may necessitate further surgery.

Prevention

Move carefully and gently stand up. Wear supportive footwear and avoid going barefoot. Inquire about walking assistance like a cane or walker. Railings or nonslip cushions may be installed in your home, particularly in the bathroom.

Recovery and Care

• After the operation, your kid will be kept in the recovery area until they are awake and ready to be transferred to the ward.
• Unless the surgeon instructs differently, they must lie flat for 24-48 hours (although they may shift from side to side and onto their tummy).
• Nurses on the ward will help with toileting, pain treatment, and pressure area care, and will keep a close eye on your child’s recovery.
• While your child must remain flat, a tube may be put in their bladder to drain urine.

After surgery, most children will spend 5-7 days in the hospital. It will be necessary to keep the wound clean and dry. Any leakage from the wound or evidence of infection must be reported to the doctors as soon as possible while in the hospital and/or after being discharged. Before you go home, the wound will be examined by doctors and new dressings will be applied. A physiotherapist will check your kid during their hospital stay to ensure that they are safe to move around and to answer any questions you may have.