Ailawadhi Pankaj, Kale S S, Agrawal Deepak, Mahapatra A K, Kumar Rajeev
Department of Neurosurgery and Urology, All India Institute of Medical Sciences, New Delhi, India.
Pediatr Neurosurg. 2012;48(4):210-5. doi: 10.1159/000345829. Epub 2013 May 24.
Primary tethered cord syndrome refers to a group of neural tube defects that are not externally obvious, and, if detected at an early age, surgical intervention may prevent the significant irreversible neurological deficits. This study was performed to evaluate the presenting clinical features of patients with primary tethered cord syndrome and the indications of surgery in such patients as well as the clinical and urological outcome. In all cases, the indication for surgery was the presence of a tethered cord on magnetic resonance imaging, the criteria for tethering being a low-lying conus (below L1-L2) and a thickened filum (>2 mm). Urodynamic studies were performed before detethering. Microsurgical detethering of low-lying cord was then performed, and the patients were then followed clinically and urologically for 6 months. Pain responded the most to detethering while limb weakness and urological symptoms responded the least. Clinical improvement in urological symptoms correlated with improvement in urodynamic parameters. A urodynamic study identified improvement in a larger number of patients and also deterioration in a few patients which was not visible clinically; this may point to its high sensitivity and usefulness in preceding clinical manifestations in a future follow-up.
原发性脊髓栓系综合征是指一组体表无明显异常的神经管缺陷，若在早期发现，手术干预可预防严重的不可逆神经功能缺损。本研究旨在评估原发性脊髓栓系综合征患者的临床表现、此类患者的手术指征以及临床和泌尿系统结局。所有病例中，手术指征为磁共振成像显示存在脊髓栓系，栓系标准为圆锥低位（低于L1-L2）和终丝增粗（>2mm）。在解除栓系前进行尿动力学检查。然后对低位脊髓进行显微手术解除栓系，随后对患者进行6个月的临床和泌尿系统随访。疼痛对解除栓系的反应最为明显，而肢体无力和泌尿系统症状的反应最小。泌尿系统症状的临床改善与尿动力学参数的改善相关。尿动力学检查发现更多患者有改善，也有少数患者病情恶化，而临床未见明显变化；这可能表明其在未来随访中对临床表现具有较高的敏感性和实用性。
