Daszkiewicz Paweł, Barszcz Sławomir, Roszkowski Marcin, Maryniak Agnieszka
Oddział Neurochirurgii IPCZD, Al. Dzieci Polskich 20, 04-736 Warszawa, Poland.
Neurol Neurochir Pol. 2007 Sep-Oct;41(5):427-35.
Tethered cord syndrome (TCS) consists of solid adhesion of the distal spinal cord to adjacent structures, resulting in repetitive spinal cord traction during truncal movements. The condition is usually a sequel of lumbosacral dysraphism, spinal cord injury or surgical procedure. Clinical signs of TCS include sphincter disturbances, lumbosacral pain, sensorimotor deficits and orthopaedic deformity. The aim of this study was to assess long-term results of surgical treatment of TCS in children and to define any prognostic factors associated with long- -term outcome.
Between 1980 and 2005, we treated 59 children with TCS. The group included 22 boys and 37 girls (mean age at surgery: 7.7 years). In total, 75 surgical procedures were performed. Mean follow-up time was 4.4 years.
Meaningful clinical improvement was obtained in 19 children (32.2%) and was more pronounced in lower extremities than in sphincters. Degree of untethering was the only factor significantly influencing outcome. Neither age at surgery nor severity of spinal cord traction had any prognostic value. Significant correlations were found between severity of pre-existing myelopathy and development of neurogenic bladder, independently of treatment instituted. There was no permanent morbidity and perioperative mortality was nil.
Late results of surgical treatment of TCS in children are generally unsatisfactory - worthwhile improvement was obtained in about 1/3 of patients only. Improvement was more pronounced in lower extremities than in sphincters. The sole factor contributing to good functional outcome was complete untethering of the cord. The decision whether to operate on a child with TCS must be based on coherent clinical, radiological and urological premises; surgery should be performed before irreversible deficits appear.
脊髓拴系综合征（TCS）是指脊髓远端与相邻结构形成牢固粘连，导致躯干运动时脊髓反复受到牵拉。该病通常是腰骶部脊柱裂、脊髓损伤或外科手术的后遗症。TCS的临床症状包括括约肌功能障碍、腰骶部疼痛、感觉运动功能缺损和骨科畸形。本研究的目的是评估儿童TCS手术治疗的长期效果，并确定与长期预后相关的任何预后因素。
1980年至2005年间，我们治疗了59例TCS患儿。该组包括22名男孩和37名女孩（手术时平均年龄：7.7岁）。共进行了75次外科手术。平均随访时间为4.4年。
19名患儿（32.2%）获得了有意义的临床改善，下肢改善比括约肌更明显。松解程度是唯一显著影响预后的因素。手术年龄和脊髓牵拉严重程度均无预后价值。发现术前脊髓病的严重程度与神经源性膀胱的发生之间存在显著相关性，与所采取的治疗方法无关。无永久性并发症，围手术期死亡率为零。
儿童TCS手术治疗的后期结果总体上不尽人意——仅约1/3的患者获得了有价值的改善。下肢改善比括约肌更明显。导致良好功能预后的唯一因素是脊髓完全松解。对于TCS患儿是否进行手术的决定必须基于连贯的临床、放射学和泌尿学依据；手术应在不可逆缺陷出现之前进行。
