Rajpal Sharad, Tubbs R Shane, George Timothy, Oakes W Jerry, Fuchs Herbert E, Hadley Mark N, Iskandar Bermans J
Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin, USA.
J Neurosurg Spine. 2007 Mar;6(3):210-5. doi: 10.3171/spi.2007.6.3.210.
Children with spina bifida occulta require early surgery to prevent neurological deficits. The treatment of patients with a congenitally tethered cord who present in adulthood remains controversial.
The authors studied the medical records of 61 adult patients who underwent surgical untethering for spina bifida occulta at three institutions between 1994 and 2003. Patients who had undergone prior myelomeningocele repair or tethered cord release surgery were excluded. The most common intraoperative findings were lipomyelomeningocele (41%) and a tight terminal filum (36%). The follow-up duration ranged from 10.8 to 149.5 months. Of the 34 patients with back pain, status improved in 65%, worsened in 3%, remained unchanged in 18%, and improved and later recurred in 15%. Lower-extremity pain improved in 16 patients (53%), remained unchanged in 23%, improved and then recurred in 17%, and worsened in 7%. Lower-extremity weakness improved in 47%, remained unchanged in 47%, and improved and then recurred in 5%. Finally, of the 17 patients with lower-extremity sensory changes, status improved in 35%, remained unchanged in 35%, and the information on five patients was unavailable. Surgical complications included three wound infections, one cerebrospinal fluid leak, and two pseudomeningoceles requiring surgical revision. One patient developed acute respiratory distress syndrome and sepsis postoperatively and died several days later.
Adult-age presentation of a congenital tethered cord is unusual. Despite a slight increase in postoperative neurological injury in adults, surgery has relatively low risk and offers good potential for neurological improvement or stabilization. As they do in children, the authors recommend early surgery in adults with this disorder. The decision to undertake surgery, however, should be modulated by other factors such as a patient's general medical condition and risk posed by anesthesia.
隐性脊柱裂患儿需要早期手术以预防神经功能缺损。对于成年期出现先天性脊髓栓系的患者，其治疗仍存在争议。
作者研究了1994年至2003年间在三个机构接受隐性脊柱裂手术松解的61例成年患者的病历。排除曾接受过脊髓脊膜膨出修复术或脊髓栓系松解手术的患者。最常见的术中发现是脂肪瘤型脊髓脊膜膨出（41%）和紧张的终丝（36%）。随访时间为10.8至149.5个月。在34例背痛患者中，65%的患者症状改善，3%的患者症状恶化，18%的患者症状无变化，15%的患者症状改善后复发。16例下肢疼痛患者中，53%的患者症状改善，23%的患者症状无变化，17%的患者症状改善后复发，7%的患者症状恶化。47%的下肢无力患者症状改善，47%的患者症状无变化，5%的患者症状改善后复发。最后，在17例下肢感觉改变的患者中，35%的患者症状改善，35%的患者症状无变化，5例患者的信息未提供。手术并发症包括3例伤口感染、1例脑脊液漏和2例需要手术修复的假性脑脊膜膨出。1例患者术后发生急性呼吸窘迫综合征和败血症，数天后死亡。
先天性脊髓栓系在成年期出现并不常见。尽管成人术后神经损伤略有增加，但手术风险相对较低，且有较好的神经功能改善或稳定的潜力。与儿童一样作者建议患有这种疾病的成年人尽早手术。然而，手术决策应受其他因素调节，如患者的一般身体状况和麻醉风险。
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