Foreign body reactions causing spinal cord tethering: a case-based update.
BACKGROUND
Patients operated on for myelomeningocele (MMC) and lipomeningocele (LMC) can suffer from late functional worsening that, in many cases, is due to spinal cord tethering by the post-repair scarring process.


METHODS
In this case-based update, we report two patients operated on for MMC and LMC, respectively, who presented the clinical manifestations of spinal cord tethering, which we attributed to severe foreign body reactions to the materials used at their primary back surgery. In the first case, the cause of the tethering was an intense fibrotic scar around the silk suture used at the initial MMC repair, while in the second one, it was due to a fibrotic mesh containing the lyophilized dural graft implanted for LMC surgery. After a search of the current literature, we were unable to find cases of spinal cord tethering related to excessive scarring after dural repair with foreign materials used for the surgical correction of spinal dysraphism.


CONCLUSIONS
The pathogenesis of spinal cord tethering in our instances closely relate with the histopathologically observed intense foreign body reaction around the materials used at the primary back surgery. We recommend avoiding as much as possible the use of foreign materials during the initial repair of spinal dysraphism.
Martínez-Lage
Juan F
JF
Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar, 30120 Murcia, Spain. juanf.martinezlage@cablemurcia.com
Ferri Niguez
Belen
B
Almagro
María José
MJ
Rodriguez
María Cristina
MC
Pérez-Espejo
Miguel A
MA
D005260:Female; D005549:Foreign-Body Reaction / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D008588:Meningocele / Q000601:surgery; D008591:Meningomyelocele / Q000601:surgery; D009436:Neural Tube Defects / Q000209:etiology*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects; D013537:Sutures / Q000009:adverse effects