Dr. Bex
speaker
498 appearances
7 recordings
1 series
first heard Nov 2024
last heard Jun 2025
Dr. Bex’s voice in public audio — every appearance, attributed to the second.
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All of that can be associated with a primary tether cord. There is something called a secondary tethered cord, meaning you get it or develop it later in life. In most cases, that is related to scarring from previous surgeries, traumas, tumor resections, anything where you actually get in that area and could cause scar tissue.
Once someone has scar tissue in a certain area, they are at risk then of later death. Symptoms or complications. And so a tethered cord causes, if you think about it, because of where it is, it's all issues kind of from your waist down. So it's numbness, shooting pains in your legs, typically bowel and bladder issues because of the location of that. You can have issues with how you walk.
And the way we diagnose it in medicine, the standard of care, gold standard, is an MRI. And it's what's called a static MRI, meaning you're just taking pictures for one moment in time. And you may see the actual tethering of the cord. If you look it up, the pictures are kind of cool, but it's actually tethered. Or you will see that that area is thickened compared to other patients.
So this, if it makes sense, talking about Ehlers-Danlos and Chiari malformation, the idea is, again... If all of your ligaments are lax and if there's issues with how your collagen forms or how all of those tissues form, in EDS, could they be at higher risk of allowing this cord to kind of be more thickened or be more tight?
Or over time, there are some neurosurgeons who say that it could kind of tether secondarily because of all the stress associated. due to this underlying disorder.
What is different, I think, about tethered cord versus Chiari is they are calling something what's called an occult tethered cord, O-C-C-U-L-T, occult, that the idea is the MRI is normal, so you don't see the tethering, you don't see the thickening. And the idea is because they're having the symptoms of a tethered cord, they can still benefit from a procedure untethering the cord. Okay.
That's where the... differing views come. I think true classic tether cord, true classic Chiari, there is a lot of research on, although again, the randomized controlled studies are maybe a little bit lacking, but much more long-term data, studies, things to show. And a lot of the cases are asymptomatic, watch and wait, high enough risk, you may intervene preemptively to prevent symptoms.
Low risk, incidental finding, meaning you do an MRI because the kid fell and hit his head and you find a Chiari, but no symptoms, you may watch and wait. And then if imaging shows it, symptoms go along with it, concern for long-term symptoms, at that point, it becomes more of, the surgery becomes much more the standard of care.
If you look at it, most times a Chiari repair or a tethered cord repair are considered elective procedures because the decision is made that the benefit of the surgery, right, would overcome the risk of the surgery.
So even though it's technically, it's not emergent, you don't have to do it today or something bad might happen, but the idea is it is now recommended because you're having the symptoms.
I've had kids who can't swallow. They develop aspiration, dysphagia. Those are the more severe cases. And those are the ones I've seen actually diagnosed much earlier and younger. And even those are difficult because you're doing, I mean, again, guys, this is neurosurgery. I mean, I just want to put that out there. Like this is brain and spinal cord. This is everything without it.
I mean, so scary, right? Yeah. And I know that like-
But I think having that full approach is a very important piece that if they are not in the right place to have, I'm talking more in the more elective versions, but like if they're not in the right place to go through a major surgery, That could have devastating outcomes. You know, if the pain was not managed before, the question is, how will we manage the pain after?
Because there may be a period of time where pain is worse. And so patients with Ehlers-Danlos, to be fair, because of all the laxity and everything, they do live with chronic pain. A lot of them do. And so, but that changes your tolerance to pain as well. So postoperative pain is going to be different, right? than preoperative pain. I'm not saying better or worse. It may be different.
And so I think always prepping anyone going into this kind of a major surgery for what this might look like, what our plans are to manage it. And, you know, really making sure it's that whole, the whole team approach. And I'm not talking more tests, more of this. I'm talking behavioral health, maybe if it's appropriate, a pain management team, if it's appropriate.
If we prepare ahead of time, I feel like the outcomes are better after versus promising things or someone coming into it thinking this is going to change everything and change my whole life. But honestly, if you still have Ehlers-Danlos, some of your chronic pain may still be there.
And I think being very upfront about that, that maybe we're hoping this whatever it is might work, but understand that there's still all these other things playing into it.
Yeah, that's good context.
The exclusion criteria.
So there is something called median arcuate ligament syndrome. These all have these acronyms. So it's MALS, it's M-A-L-S. The idea is in our abdominal cavity, we have a lot of things that are supposed to develop in form and be in the right place and not compress anything else.
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