Clinical analysis of tethered cord syndrome and gene expression profiling of wound healing surgery

Introduction:
The method to prevent progression of symptoms in tethered cord syndrome (TCS) is neurosurgery. However, postoperative wound healing is a lengthy process and is hindered by the release of cerebrospinal fluid (CSF) through the wound. To the best of the authors’ knowledge, there is no study evaluating the changes in the expression of factors involved in the wound healing process after neurosurgery for TCS.

Aim:
To clinically analyse two cases of TCS and evaluate the change in expression of selected genes during the postoperative wound healing process.

Material and methods:
Determination of TCS in two adult patients (woman, aged 26 years; man, aged 53 years) was based on magnetic resonance imaging (MRI). After confirming the initial diagnosis, a neurosurgical procedure was performed to remove the intrathecal spreading adipoma and transect the medullary terminal thread in patients. In the postoperative period, impaired wound healing was noted as a result of CSF secretion through the surgical wound.

Results:
Molecularly, there was an increase in expression of all genes assessed in skin biopsy specimens compared to skin samples. Impaired postoperative wound healing after neurosurgery for TCS is expected due to CSF leakage through the surgical wound. The greatest changes were noted for metalloproteinases (MMPs) and four isoforms (A–D) of vascular endothelial growth factor A-D (VEGF-A-D; p < 0.05).

Conclusions:
Changes in the expression of our selected genes can be used to monitor and predict the process of wound healing and scar formation, which occurred in our cases at 19 and 20 days after surgery.