Cord untethering for lipomyelomeningocele: expectation after surgery
Bibliographic record
Abstract
The natural history of cord tethering in transitional LMMC remains unclear. Not all children suffer deterioration,and, in a significant proportion, function is not normal at birth. Surgery, as it is currently practiced, is generally safe but does not confer long-term immunity from deterioration. The risk of deterioration, its pattern, and its timing are related in part to the morphology of the malformation. Patients with asymmetrical malformations may exhibit unilateral functional neurological or orthopedic abnormalities, which conspire with normal neurodevelopment to render these abnormalities apparent at an early age. Symmetrical malformations present later in childhood in association with bilateral and/or urinary dysfunction. The rate of functional deterioration in patients following surgery appears to be equal to or is slower than the rate of deterioration in patients who do not undergo surgery. Many patients will require more than one untethering procedure to address evolving functional impairment. Structural abnormalities require end organ-specific orthopedic or urological interventions. A formal structured multidisciplinary monitoring team is required to provide clinical and functional surveillance. Such monitoring is required following operative untethering and debulking for the life of the patient. The author reviewed current literature to define the timing and pattern of deterioration prior to and following initial cord untethering in patients with transitional LMMC, as well as the operative burden that these children bear in exchange for optimized function.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".