Drake James M
Division of Neurosurgery, Department of Neurosurgery, University of Toronto, Ontario, Canada.
J Neurosurg. 2006 May;104(5 Suppl):305-8. doi: 10.3171/ped.2006.104.5.305.
The author describes the paucity of information known about occult tethered cord syndrome and summarizes the argument for using a nonsurgical approach in these cases.
A review of what we do and do not know about this syndrome is provided. Surgical procedures to divide the terminal filum in patients with symptoms of tethered spinal cord without the imaging correlates are said to result in clinical improvement, yet there is little physiological evidence to support the surgical release of the filum in the absence of other anatomical lesions. Validated diagnostic and outcome measures are also lacking, which makes the interpretation of reported results exceedingly difficult. Finally, reports used to support surgical intervention are limited by small size, the absence of control groups, and observer bias.
Without conclusive clinical evidence, the arguments supporting surgery for occult tethered cord syndrome must be viewed cautiously.
作者描述了关于隐匿性脊髓拴系综合征已知信息的匮乏，并总结了在这些病例中使用非手术方法的依据。
对我们已知和未知的关于该综合征的情况进行了综述。在没有影像学关联的情况下，对有脊髓拴系症状的患者进行终丝切断的手术操作据说能带来临床改善，但几乎没有生理学证据支持在没有其他解剖学病变的情况下对终丝进行手术松解。同时也缺乏经过验证的诊断和结果测量方法，这使得对报告结果的解读极其困难。最后，用于支持手术干预的报告存在样本量小、缺乏对照组和观察者偏倚等局限性。
在没有确凿临床证据的情况下，支持隐匿性脊髓拴系综合征手术治疗的观点必须谨慎看待。
