Neuro-spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Spine (Phila Pa 1976). 2011 Jun 15;36(14):E944-9. doi: 10.1097/BRS.0b013e3181fc2edd.
A retrospective review of coronal spine balance after tethered cord release for children with tight filum terminale.
To understand the effects of untethering on coronal spine balance for these patients.
In patients with tight filum terminale, the spinal cord is tethered by a thickened filum with a low conus medullaris but without other forms of spinal dysraphism. There have not been studies examining the effects of spinal cord untethering on coronal spinal alignment in children with tight filum terminale.
Forty-five consecutive pediatric patients with tight filum terminale who had undergone untethering were evaluated. Their presenting signs and symptoms, pre- and postsurgery imagings, and clinical courses were reviewed for scoliosis progression.
Twenty-six girls and 19 boys underwent tethered cord release at a mean age of 4.5 years. The prevalence of coronal spinal malalignment, manifesting as scoliosis, before the untethering procedure was 31% (14 of 45). During the follow-up period, nine patients had coronal spinal alignment that worsened>10° (five patients eventually underwent surgical fusion), two patients had spinal alignment that improved, and five patients' curves stabilized after untethering surgery. Therefore, at the end of the follow-up period, 9 of 45 patients (20%) had worsened coronal spinal alignment. In the multivariate analysis, patients who presented with a Cobb angle greater than 35° were most likely to progress (P=0.002, odds ratio=21). There was no operative morbidity or mortality associated with scoliosis surgery.
A significant number of children with tight filum terminale were found to present with scoliosis. In patients with less severe curves, tethered cord release may halt scoliosis progression.
回顾性分析终丝紧张的儿童行脊髓栓系松解术后冠状位脊柱平衡的变化。
了解脊髓松解对这些患者冠状位脊柱平衡的影响。
在终丝紧张的患者中，脊髓被增厚的终丝牵拉，圆锥位置较低，但无其他形式的脊柱脊膜膨出。目前尚无研究探讨脊髓松解对终丝紧张儿童冠状位脊柱排列的影响。
评估了 45 例连续接受脊髓松解术的终丝紧张的儿科患者。回顾了他们的就诊症状、术前和术后影像学资料以及临床经过，以了解脊柱侧凸进展情况。
26 名女孩和 19 名男孩在平均年龄为 4.5 岁时接受了脊髓栓系松解术。在松解术前，31%（45 例中的 14 例）存在冠状位脊柱失平衡，表现为脊柱侧凸。在随访期间，9 例患者的冠状位脊柱排列恶化>10°（5 例最终接受了手术融合），2 例患者的脊柱排列改善，5 例患者的曲线在松解术后稳定。因此，在随访结束时，45 例患者中有 9 例（20%）出现冠状位脊柱排列恶化。多变量分析显示，初始 Cobb 角>35°的患者更有可能进展（P=0.002，优势比=21）。脊柱侧凸手术无手术并发症或死亡。
发现相当数量的终丝紧张儿童存在脊柱侧凸。对于曲线较轻的患者，脊髓松解可能会阻止脊柱侧凸的进展。
