Supraplacode spinal cord transection in paraplegic patients with myelodysplasia and repetitive symptomatic tethered spinal cord.

Abstract

The authors describe the technique of transecting the spinal cord in children born with myelomeningocele who have undergone multiple detherings and are functionally paraplegic. The authors' technique involves identifying the neural placode and sectioning the normal spinal cord just superior to this site. No postoperative complications have been identified in 14 patients undergoing this procedure over an 11-year period. No patient at last follow up was found to have symptoms referable to a tethered spinal cord. The advantage of this procedure is to excise the normally pia-coated cord, which is unlikely to retether compared with the neural placode, which is often covered with scar tissue and does not have a well-formed pial surface--hence, predisposing it to frequent dorsal adhesions. The authors believe that this technique is of benefit in a small, carefully selected group of myelodysplastic patients with repetitive tethering of the spinal cord.