Diagnosis
Spina bifida, post-operative condition. Tethered cord syndrome. Thoracolumbar syringomyelia.
Patient:
Child, 3 years old, Kazakhstan
Physician:
Professor Martin Scholz, Chief Physician at the Duisburg Neurosurgery Clinic
Patient’s Complaints:
Our daughter was born with spina bifida, but without hydrocephalus. She underwent surgery to repair the condition on her ninth day of life. The surgery took about 45 minutes. There was suspicion of urinary leakage. At one year and three months of age, she began experiencing urinary problems. Her urine smelt, and she developed an infection. She was hospitalised. We had a consultation with a urologist this past summer, who advised us to perform bladder catheterisation every four hours, which we now do independently. She can go without wetting herself for no more than three to four hours. She currently has problems with urination and bowel movements (she has no control or sensation). Her anus is open.
There are no problems with motor function. She walks steadily, her legs are straight, and there is no foot deformity. Based on the results of the latest MRI scan, our neurosurgeon said that fluid is accumulating in the spine and that we need to consult a neurosurgeon as soon as possible.
Question for the professor:
- Is it possible to restore urinary function and resolve bowel movement problems?
- What guarantees do you offer if we have the surgery performed by you?
- What is the cost of the surgery?
- What is our exact diagnosis?
- How long will we need to stay at the clinic afterwards?
Response from neurosurgeon Professor Martin Scholz:
I have carefully reviewed and analysed all the MRI images you provided. The diagnosis of tethered cord syndrome is fully confirmed by the radiological findings. As a result of this condition, the child has already developed thoracolumbar syringomyelia, which is the formation of a fluid-filled cavity (a syrinx) in the thoracolumbar region of the spinal cord.
In this case, the decisive factor is that this syringomyelic cavity appears to be causing the worsening clinical picture, specifically the impaired bladder and bowel functions.
From a neurosurgical perspective, the patient is a candidate for surgery to correct tethered cord syndrome. During the operation, the filum terminale, which pulls the spinal cord downwards, must be severed (tethered cord release). However, it is difficult to precisely identify and isolate the structures causing the fixation in this case, as adhesions (scar tissue) and small lipomas (fatty growths) are present in the area.
To ensure maximum safety and prevent nerve damage, the surgery must be performed under intraoperative neuromonitoring (IONM), with muscle potential recordings taken from the lower extremities. This involves using special stimulation forceps that deliver a weak electrical current to the anatomical structures. This allows us to check whether the legs are responding during the surgery, for example by checking for twitching or electrical potentials detected by the equipment.
To optimise monitoring, the patient’s legs are covered with sterile transparent film and tiny needle electrodes are inserted into the muscles during surgery. This enables the surgical team to observe leg movements directly and view precise real-time readings from the instruments.
Yes, I believe that improving bladder and bowel function is entirely possible. Surgical decompression of the spinal cord eliminates excessive mechanical tension on the nervous tissue. Furthermore, thanks to the relief of this pressure, the syringomyelic cavity (syrinx) typically begins to gradually shrink after surgery. Once the pathological pressure on the nerve fibres has been relieved, the nerve endings responsible for bladder and bowel function have a real chance to recover and improve their function.
Unfortunately, in medicine and especially in neurosurgery, it is impossible to give a 100% guarantee. The extent and speed of functional recovery depend directly on the severity of any pre-existing chronic damage to the nervous structures.
We have all the necessary equipment and expertise, and we would be happy to admit the patient to our clinic for this surgery.
Estimated cost of treatment: €30,280