Dr. Bex

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.

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.

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.

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.

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.

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.

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'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'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-

I mean, so scary, right? Yeah. And I know that like-

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?

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?

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.