title: Supraplacode spinal cord transection in paraplegic patients with myelodysplasia and repetitive symptomatic tethered spinal cord.
abstract: OBJECTIVE
  The authors describe the technique of transecting the spinal cord in children born with myelomeningocele who have undergone multiple detherings and are functionally paraplegic.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Pediatric Neurosurgery, Division of Neurosurgery, University of Alabama at Birmingham, Children's Hospital, Birmingham, Alabama, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Blount
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Mamehri
authors.initials: M
authors.lastname: Okor
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Tyler-Kabara
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grabb
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002818:Cordotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009436:Neural Tube Defects / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D010264:Paraplegia / Q000209:etiology*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome