Shifting of low-lying medullary cone position of spina bifida following reconstruction surgery

Abstract

Background: Post-surgical evaluation is important for spina bifida patients with low-lying medullary cone including measurement of medullary cone position after being treated. This study aimed to evaluate contributing factors of medullary cone ascending following reconstruction surgery.Methods: This was a descriptive study including low-lying medullary cone spina bifida patients who underwent reconstructive surgery at the Department of Neurosurgery, Cipto Mangunkusumo Hospital, Jakarta, from May 2015 to May 2016. Preoperative and postoperative medullary cone position were evaluated using 1.5 Tesla Magnetic Resonance Imaging (MRI).Results: Eight low-lying medullary cone spina bifida patients who had reconstructive or untethering surgery were included in this study. We found six patients (75%) who had shifting of medullary cone level after surgery. Ascending of medullary cone level to L2 was found in 1 patient (12.5%) of pre-school age group, between 3 – 5 years old. All patients had intradural scar which were shown on post-operative MRI. Primary closure of duramater was performed to all patients. Post-operative MRI assessment at 6 months showed ascending of medullary cone 2 to 3 levels in most patients compared to those who had post-operative MRI assessment in less than 6 months.Conclusion: Age at surgery, surgical technique using primary closure of duramater, and timing of post-operative radiological examination affects shifting of medullary cone position following reconstructive surgery.Keywords: low-lying medullary cone, spina bifida, untethering