Proctor M R, Scott R M
Department of Neurosurgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Neurosurg Focus. 2001 Jan 15;10(1):e5. doi: 10.3171/foc.2001.10.1.6.
Split cord malformations (SCMs) are relatively rare forms of occult spinal dysraphism (OSD) and tethered spinal cord syndrome. The majority of these cases present in early childhood, with neurocutaneous stigmata being an early presenting feature. Prophylactic detethering surgery is advocated by most neurosurgeons due to the risk of neurological deterioration over time caused by patient growth and activity. However, unlike other forms of OSD, the course of SCM progression after surgery is not well understood, and little has been published about long-term followup results. In this study the authors review the results obtained in 16 patients in whom the senior author performed surgery over a 13-year period (average length of follow up almost 8 years).
Presentation, surgical approach, and outcome are evaluated, and the long-term outcome of neurological status, pain, bowel/bladder disturbance, and spinal deformities are emphasized.
The primary conclusion is that patients with SCM generally tolerate surgery well and experience few complications. Neurological deterioration is rare except in cases in which retethering occurs, (two patients in this series). Although impaired bowel and bladder function was stabilized or improved and pain was reliably relieved postoperatively, preexisting vertebral column deformities usually progressed after surgery and, in most cases, required spinal fusion.
脊髓纵裂畸形（SCM）是隐性脊柱裂（OSD）和脊髓拴系综合征中相对少见的类型。这些病例大多在儿童早期出现，皮肤神经斑是早期表现特征。由于患者生长和活动会导致神经功能随时间恶化，大多数神经外科医生主张进行预防性脊髓松解手术。然而，与其他形式的OSD不同，SCM术后的病情进展过程尚未得到充分了解，关于长期随访结果的报道也很少。在本研究中，作者回顾了资深作者在13年期间对16例患者进行手术（平均随访时间近8年）所获得的结果。
对患者的临床表现、手术方式及结果进行评估，并着重关注神经功能状态、疼痛、肠道/膀胱功能障碍及脊柱畸形的长期结果。
主要结论是，SCM患者通常对手术耐受性良好，并发症较少。除了发生再拴系的病例（本系列中有2例患者）外，神经功能恶化很少见。虽然术后肠道和膀胱功能障碍得到稳定或改善，疼痛也得到可靠缓解，但术前就存在的脊柱畸形通常在术后仍会进展，且在大多数情况下需要进行脊柱融合手术。
