The term "tethered cord" is overloaded with two meanings. This is article about spinal cords which have scar tissue (or adhesive arachnoiditis) attaching them to the dura at any level, not about the controversial "occult tight filum terminale" tethered cord.
This article, Untethering the Invisible Knot, follows a group of patients with varying degrees of partial paralysis as they try cord detethering sugery to try to preserve or restore neurologic function.
What I like about this article is the stories of strong people who are living with spinal cord injuries (SCI). I also like the realistic reports of surgical outcomes. I feel like most neurosurgeons have a excessively optimistic view of their outcomes, which is reflected in the very positive statistics they report. When you talk to patients, you get a different view of surgical outcomes.
I believe any intradural spine surgery is very risky, and that the scarring and inflammation caused by the surgery often negate any initially positive results.
If I may get on the soapbox for a moment, I'd like to urge neurosurgeons to be more scientific about their outcomes. Having a neutral third party doing pre- and post-surgical assessments would yield a more accurate picture of true patient outcomes. I know this is easier said than done but I've found the current set of outcome data presented by neurosurgeons to be, at times, significantly optimistic.
Tuesday, June 16, 2009
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