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Surgery is the only effective treatment and will usually be recommended in cases where the tethered cord is causing symptoms. In straightforward cases of fatty or tight filum, the actual surgery takes only about an hour. Lipoma cases are somewhat more involved and may take longer or require more than one surgery as the child grows.
With the child under anesthesia, the surgeon makes a small (about 1 inch) opening in the skin and proceeds to open a space between the bones and into the spinal canal. Occasionally, they may need to remove a small amount of bone to get to the spinal canal, but that normally grows back after surgery. Under a surgical microscope, the surgeon carefully separates the spinal cord from the tissue that binds it. Electrodes are used to monitor the muscle and nerve response throughout the surgery in order to avoid damaging the nerve roots. This requires a special kind of anesthesia.
After the spinal canal and the skin incision are sewn closed, nurses will bring the child to the recovery room, where parents may join them. As in all surgeries, there is a very small risk of bleeding or infection at the surgical site. There is also a small risk that spinal fluid can leak out through the incision, but that risk is minimized by keeping the patient lying flat for the first 24 hours.
Usually, the child can return to normal activity when they return home. Parents must take special care to keep the area near the incision clean, especially when children are still in diapers.
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