Selçuki Mehmet, Umur Ahmet Sükrü, Duransoy Yusuf Kurtulus, Ozdemir Seymen, Selcuki Deniz
Neurosurgery Department, Celal Bayar University, Medical School, 1403 sk 5/8 Alsancak, 35220, Izmir, Turkey.
Childs Nerv Syst. 2012 Oct;28(10):1755-60. doi: 10.1007/s00381-012-1713-0. Epub 2012 Feb 17.
The causes of tethered spinal cord are various. In order to release the tethering effect of these malformations, the surgical interventions must include removal of all tethering components, reconstruction of the neural tube and sectioning of tight filum terminale as well.
The cases reported in this paper have had an operation many years before for various developmental defects. After a certain period of time (5-10 years) of the first operation, the patients reapplied to the hospital with various symptoms of spinal cord tethering, either vertical or horizontal.
At surgical intervention, it was noted that inappropriate surgical procedures caused retethering of the spinal cord in all patients. Postoperative period of all patients were uneventful. All patients declared relief in their symptoms. We would like to draw attention that untreated (or inappropriately treated) midline developmental defects will invariably cause syndrome of tethered cord. Consequently, prophylactic surgical untethering must be applied to all patients with developmental midline defects as soon as possible.
It looks that tethered cord symptoms invariably appear as enough negative influence accumulates as the time passes. Elapsed time may vary but unpleasant end result invariably arrives. While these cases with tethered spinal cord develop progressive neurological symptoms, prophylactic and appropriate surgical intervention should be considered as early as possible. There is no acceptable rationale to wait for the appearance of tethered cord syndrome symptoms to perform surgical untethering of the spinal cord because of the probability of irreversibility of the symptoms (incontinence of urine in particular) of tethered spinal cord syndrome.
脊髓拴系的病因多种多样。为解除这些畸形的拴系效应，手术干预必须包括切除所有拴系成分、重建神经管以及切断紧张的终丝。
本文报道的病例多年前因各种发育缺陷接受过手术。首次手术后经过一段时间（5 - 10年），患者因脊髓拴系的各种症状再次就医，这些症状既有纵向的也有横向的。
在手术干预时注意到，所有患者均因不恰当的手术操作导致脊髓再次拴系。所有患者术后恢复顺利。所有患者均称症状缓解。我们想提请注意，未经治疗（或治疗不当）的中线发育缺陷必然会导致脊髓拴系综合征。因此，对于所有有中线发育缺陷的患者，必须尽早进行预防性手术松解。
看起来随着时间推移，当足够多的负面影响积累时，脊髓拴系症状总会出现。时间间隔可能不同，但不愉快的最终结果总会到来。当这些脊髓拴系病例出现进行性神经症状时，应尽早考虑进行预防性和恰当的手术干预。由于脊髓拴系综合征症状（尤其是尿失禁）可能不可逆转，所以没有可接受的理由等待脊髓拴系综合征症状出现后再进行脊髓手术松解。
