Fabiano Andrew J, Khan Mohammed F, Rozzelle Curtis J, Li Veetai
Department of Neurosurgery, Women and Children's Hospital of Buffalo, Kaleida Health, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Pediatr Neurosurg. 2009;45(4):256-61. doi: 10.1159/000228983. Epub 2009 Jul 17.
BACKGROUND/AIMS: An occult tight filum terminale syndrome has been described wherein clinical symptoms result from tension on the spinal cord despite nondiagnostic spinal magnetic resonance imaging (MRI). Recent reports have suggested a role for surgical untethering in this patient population; however, controversy remains regarding the surgical treatment of this condition. Owing to the various clinical presentations, the relationship of presenting signs and symptoms to postoperative outcomes might be useful in surgical selection.
A retrospective review was conducted of 22 pediatric cases of surgical untethering for suspected occult tight filum terminale syndrome. All patients had nondiagnostic MRI findings, defined as a conus medullaris above the L(3) vertebral body and a filum terminale diameter of less than 2 mm. Preoperative symptoms, signs and urodynamic test results were collected and compared with surgical outcomes determined by clinical notes and postoperative urodynamics reports. Abnormal findings on presentation were categorized as dermatologic, urologic, orthopedic and neurologic.
Patient age ranged from 7 months to 17 years, and 12 were female. Sixteen (73%) patients experienced subjective and/or objective improvement following surgical untethering. Fourteen patients had abnormal preoperative urodynamic testing, of which 12 underwent postoperative urodynamic testing. Five of these 12 (42%) demonstrated objective improvement postoperatively. Patients presenting with abnormal findings in at least 2 categories were more likely to improve following untethering (88%) than those with abnormalities in only 1 category (20%; p = 0.009).
Spinal cord untethering is a treatment option for occult tight filum terminale syndrome. Further evaluation of the relationship between preoperative findings and surgical outcomes may facilitate the selection of surgical candidates.
背景/目的：隐匿性终丝紧张综合征已被描述，尽管脊髓磁共振成像（MRI）未确诊，但临床症状是由脊髓张力引起的。最近的报告表明手术松解在该患者群体中具有作用；然而，对于这种疾病的手术治疗仍存在争议。由于临床表现多样，呈现的体征和症状与术后结果之间的关系可能有助于手术选择。
对22例疑似隐匿性终丝紧张综合征行手术松解的儿科病例进行回顾性研究。所有患者的MRI检查结果均未确诊，定义为脊髓圆锥位于L3椎体上方且终丝直径小于2mm。收集术前症状、体征和尿动力学检查结果，并与临床记录和术后尿动力学报告确定的手术结果进行比较。呈现的异常发现分为皮肤、泌尿、骨科和神经科。
患者年龄从7个月至17岁不等，其中12例为女性。16例（73%）患者在手术松解后主观和/或客观症状改善。14例患者术前尿动力学检查异常，其中12例术后进行了尿动力学检查。这12例中的5例（42%）术后显示客观改善。至少在2个类别中存在异常发现的患者在松解后改善的可能性（88%）高于仅在1个类别中存在异常的患者（20%；p = 0.009）。
脊髓松解是隐匿性终丝紧张综合征的一种治疗选择。进一步评估术前发现与手术结果之间的关系可能有助于手术候选者的选择。
