Joel Haakon Borgstedt-Bakke, Morten Fenger-Grøn and Mikkel Mylius Rasmussen
The aim of this study was to assess myelomeningocele mortality, correlate these findings to lesion level, and investigate mortality evolution.
From the population-based western Denmark myelomeningocele database, the authors extracted the records of 187 patients born between January 1, 1970, and July 1, 2015. Patients were categorized according to their most rostral lesion level into cervical, thoracic, lumbar, or sacral groups. Furthermore, patients were categorized based on their birth dates (1970–1979, 1980–1989, and 1990–2015). Mortality data was extrapolated from the university hospital's electronic charts, which are based on the Danish Civil Registration System, and compared according to mortality, lesion level, and date of birth. Data were also extracted from nationwide Danish registers. Additionally, the authors divided the patients according to date of birth before or after the advent of prenatal detection (2004), and compared mortality rates of these two groups.
A thoracic lesion level was associated with a significantly higher mortality rate (p = 0.01). Two patients had a cervical lesion and were alive at the end of follow-up. The mortality rate decreased over time, although not significantly for the subsequent time periods. Prenatal detection did not affect mortality.
The presented data suggest increased mortality with ascending lesion level in patients with myelomeningocele, except for patients with cervical lesions. The mortality rate improved over time, suggesting that modern treatment modalities improve survival in patients with myelomeningocele.
Joel Haakon Borgstedt-Bakke, Thea Overgaard Wichmann, Gudrun Gudmundsdottir and Mikkel Mylius Rasmussen
The goal of this study was to establish an incidence and assess the effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele.
The study population was based on the Western Denmark Myelomeningocele Database, which contains all patients born with myelomeningocele in western Denmark since 1970. The study population was cross-referenced in 2015 with a database for surgical procedures containing all surgical procedures performed in the central Denmark region since 1996. Patients alive between 1996 and 2015 were identified. Incidences was calculated and presented for year of age. File reviews were conducted for all patients who underwent the procedure. Follow-up was divided into short-term and long-term follow-up.
One hundred sixty-six patients were alive during various time periods between 1996 and 2015. Of these, 45 patients underwent the procedure. Seven underwent reoperation. The median age for the procedure was 12 years and the highest incidence was found at 15 years of age. Incidence was bimodal with highest incidence in children and adolescents. The most common indications were progressive spine deformity (40%), deteriorating ambulation (38%), and deteriorating neurogenic bladder and/or bowel dysfunction (32%). The mean short-term follow-up was 4.7 months and the mean long-term follow-up was 72.6 months. Postoperatively, the majority had improved (27%) or stabilized (27%) at short-term follow-up. At long-term follow-up, most patients were stable (27%) or had deteriorated (24%). For both follow-up terms there was a loss of approximately one-third of all patients. Complications occurred in 17% of the procedures.
In this population-based study, tethered cord release has the highest incidence in children and adolescents. The beneficial effect of the procedure seems to be short term. Due to the uncertainty of a long-term effect of the procedure in patients with myelomeningocele and the registered complications, the authors suggest that this surgical indication should be reserved for well-selected patients.
Mette Haldrup, Stig Dyrskog, Mathias Møller Thygesen, Hans Kirkegaard, Helge Kasch and Mikkel Mylius Rasmussen
Patients with traumatic spinal cord injury (TSCI) are at risk of developing neurogenic shock that causes hypotension and thereby secondary injury to the spinal cord due to ischemia. Hemodynamic treatment of patients with acute TSCI remains inadequately elucidated. Guidelines for management are divergent and based on limited evidence. To this end, the authors evaluated whether mean arterial blood pressure (MABP) during the prehospital and initial hospital phases of TSCI treatment is correlated with long-term neurological outcome.
The authors performed a retrospective cohort study based on a chart review of MABP data collected during the prehospital transport, in the operating room (OR), and in the neurointensive care unit (NICU) during the first 7 days after trauma. Data from the NICU were divided into two periods: days 1–2 and days 3–7. Data were analyzed using Spearman’s rank correlation to evaluate for any correlation between MABP and changes in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) score 1 year postinjury. In the analysis, the MABP target value was 80 mm Hg. Hypotension was treated with metaoxedrin or norepinephrine. Statistically significant differences were evaluated using Spearman’s rank correlation coefficient.
The chart review yielded 129 patients treated for TSCI. The inclusion period was 2010–2017. For the prehospital transport measurements of MABP, the Spearman’s rank correlation coefficient was a rho of 0.5662 (p < 0.001), for OR measurements it was a rho of 0.6818 (p < 0.001), and for the NICU measurements it was a rho of 0.4611 (p < 0.001); for NICU unit days 1–2 and days 3–7, the Spearman’s rank correlation coefficient was a rho of 0.2209 (p = 0.0681).
Continuous MABP levels exceeding 80 mm Hg have a significant impact on neurological outcome—from earliest possible stabilization in the prehospital care, through hospital admission, the surgical phase, and into the first 2 days in the NICU.