Barutçuoğlu Mustafa, Selçuki Mehmet, Umur Ahmet Sukru, Mete Mesut, Gurgen Seren Gulsen, Selcuki Deniz
Department of Neurosurgery, Celal Bayar University School of Medicine, Turkey.
Department of Histology and Embryology, Celal Bayar University Vocational School of Health Services, Turkey.
Indian J Orthop. 2016 Jan-Feb;50(1):80-6. doi: 10.4103/0019-5413.173506.
Tethered cord syndrome (TCS) is a progressive clinical entity that arises from abnormal spinal cord tension. Scoliosis may be a unique symptom in TCS. The aim of this study is to investigate prognosis after releasing the filum terminale in scoliosis due to TCS with/without findings in magnetic resonance imaging (MRI) and to draw attention to the importance of somatosensorial evoked potentials (SSEP) on the differential diagnosis of idiopathic scoliosis versus scoliosis due to TCS with normal appearance of filum terminale and conus medullaris.
Eleven female and seven male patients with progressive scoliosis were included in the study. They were evaluated radiologically, SSEP and urodynamical studies. Preoperative and postoperative anteroposterior full spine X-rays were obtained for measuring the Cobb's angle. MRI was performed in all cases for probable additional spinal abnormalities. All patients underwent filum terminale sectioning through a L5 hemilaminectomy. The resected filum terminale were subjected to histopathological examination.
The mean Cobb angle was 31.6° (range 18°-45°). Eight patients (44.45%) had a normal appearance of filum terminale and normal level conus medullaris in MRI, but conduction delay and/or block was seen on SSEP. In the histopathological examination of filum terminale dense collagen fibers, hyaline degeneration and loss of elastic fibers were observed. Postoperatively none of the patients showed worsening of the Cobb angle. Three patients showed improvement of scoliosis.
In TCS presented with scoliosis, untethering must be performed prior to the corrective spinal surgery. Absence of MRI findings does not definitely exclude TCS. SSEP is an important additional guidance in the diagnosis of TCS. After untethering, a followup period of 6 months is essential to show it untethering helps in stopping the progress of the scoliotic curve. In spite of non progression (curve stopped lesser than 45°) or even improvement of scoliosis, there may be no need for major orthopedic surgical intervention.
脊髓拴系综合征（TCS）是一种由异常脊髓张力引起的进行性临床病症。脊柱侧弯可能是TCS的一种独特症状。本研究的目的是调查在磁共振成像（MRI）有或无异常表现的情况下，因TCS导致脊柱侧弯的患者在松解终丝后的预后情况，并提请注意体感诱发电位（SSEP）在鉴别特发性脊柱侧弯与终丝和圆锥外观正常的TCS所致脊柱侧弯中的重要性。
本研究纳入了11名女性和7名男性进行性脊柱侧弯患者。对他们进行了放射学、SSEP和尿动力学研究。术前和术后均拍摄了全脊柱前后位X线片以测量Cobb角。所有病例均进行MRI检查以排查可能存在的其他脊柱异常情况。所有患者均通过L5半椎板切除术进行终丝切断术。对切除的终丝进行组织病理学检查。
平均Cobb角为31.6°（范围为18° - 45°）。8名患者（44.45%）的MRI显示终丝外观正常且圆锥位置正常，但SSEP检查发现传导延迟和/或阻滞。在终丝的组织病理学检查中观察到致密胶原纤维、玻璃样变性和弹性纤维缺失。术后所有患者的Cobb角均未恶化。3名患者的脊柱侧弯有所改善。
对于伴有脊柱侧弯的TCS患者，必须在脊柱矫正手术前进行松解。MRI无异常表现并不能绝对排除TCS。SSEP是诊断TCS的重要辅助指标。松解术后，6个月的随访期对于显示松解有助于阻止脊柱侧弯进展至关重要。尽管脊柱侧弯无进展（侧弯角度小于45°停止进展）甚至有所改善，但可能仍无需进行大型骨科手术干预。
