Liu Jia-ming, Shen Jian-xiong, Zhang Jian-guo, Zhao Hong, Zhao Yu, Li Shu-gang, Zhao Li-juan, Wang Yi-peng, Qiu Gui-xing
Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Zhonghua Wai Ke Za Zhi. 2012 Apr;50(4):333-7.
To evaluate the safety and effectiveness of correction of scoliosis associated with tethered cord without releasing it.
Twenty-two cases diagnosed as scoliosis with tethered cord between December 2005 and January 2011 were investigated retrospectively in the study. There were 8 males and 14 females. The age was from 6 to 51 years, averaged 17.7 years. There were 7 patients with clinical symptoms before surgery. All the patients underwent posterior deformity correction and instrumentation by pedicle screws directly without releasing the tethered cord. Spinal cord monitoring was conducted in all the cases. The preoperative and postoperative Cobb angle of the coronal main curve and thoracic kyphosis were measured. Also, the preoperative and postoperative values of the apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The incidence of perioperative complications were recorded.
A total of 20 patients were followed up. The follow-up time was from 6 to 52 months, mean 23.5 months. The average Cobb angle of the coronal main curve were 68° ± 20° before surgery and 38° ± 21° after surgery with a mean correction of 48.1%. The difference was significant (t = 13.9, P < 0.05). The mean kyphosis was 65° ± 18° preoperatively and 28° ± 11° postoperatively, with a correction of 56.7%. The difference was also significant (t = 8.81, P < 0.05). The preoperative values of the apical vertebra translation, apical vertebra rotation and trunk shift were (5.4 ± 2.5) cm, 2.3° ± 0.6° and (2.0 ± 1.8) cm, respectively, which were corrected to (3.2 ± 1.8) cm, 1.2° ± 0.5° and (1.5 ± 1.1) cm after the surgery. Compared to the preoperative values, the difference were significant in the apical vertebra translation (t = 5.69, P < 0.05) and apical vertebra rotation (t = 10.07, P < 0.05). However, there was no difference in trunk shift. Postoperative complications occurred in 3 patients, including transient numbness of the lower extremity in 1 patient and hydrothorax in 2 patients. No neurological and instrumentation complications occurred during the follow-ups. Patients with clinical symptoms before surgery got no serious during the surgery and follow-ups.
If there are no symptoms of tethering in scoliosis patients with tethered cord, the corrective surgeries may be safe and effective when spinal cord monitoring conducted without spinal cord untethering. But more cases are needed to confirm it.
评估在不松解脊髓栓系的情况下矫正与脊髓栓系相关脊柱侧弯的安全性和有效性。
回顾性研究2005年12月至2011年1月期间诊断为脊髓栓系合并脊柱侧弯的22例患者。其中男性8例，女性14例。年龄6至51岁，平均17.7岁。术前有7例患者有临床症状。所有患者均直接采用椎弓根螺钉进行后路畸形矫正和内固定，未松解脊髓栓系。所有病例均进行脊髓监测。测量术前和术后冠状面主弯的Cobb角以及胸椎后凸角。同时，由同一人测量术前和术后顶椎平移、顶椎旋转和躯干偏移的值。记录围手术期并发症的发生率。
共20例患者获得随访。随访时间6至52个月，平均23.5个月。术前冠状面主弯平均Cobb角为68°±20°，术后为38°±21°，平均矫正率为48.1%。差异有统计学意义（t = 13.9，P < 0.05）。术前平均后凸角为65°±18°，术后为28°±11°，矫正率为56.7%。差异也有统计学意义（t = 8.81，P < 0.05）。术前顶椎平移、顶椎旋转和躯干偏移的值分别为（5.4±2.5）cm、2.3°±0.6°和（2.0±1.8）cm，术后分别矫正为（3.2±1.8）cm、1.2°±0.5°和（1.5±1.1）cm。与术前值相比，顶椎平移（t = 5.69，P < 0.05）和顶椎旋转（t = 10.07，P < 0.05）差异有统计学意义。然而，躯干偏移无差异。3例患者出现术后并发症，包括1例下肢短暂麻木和2例胸腔积液。随访期间未发生神经和内固定相关并发症。术前有临床症状的患者在手术及随访期间病情未加重。
对于脊髓栓系合并脊柱侧弯且无脊髓栓系症状的患者，在不松解脊髓的情况下进行矫正手术并进行脊髓监测可能是安全有效的。但需要更多病例来证实。
