Abdallah Anas, Emel Erhan, Abdallah Betül Güler, Asiltürk Murad, Sofuoğlu Özden Erhan
Bezmialem Vakif University, Vatan Street, Fatih, 34093, Istanbul, Turkey.
Department of Neurosurgery, Bakırköy Research and Training Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey.
Neurosurg Rev. 2018 Jan;41(1):229-239. doi: 10.1007/s10143-017-0842-z. Epub 2017 Mar 14.
This study aimed to find the factors that may affect the surgical outcomes of congenital tethered cord syndrome (TCS) in adults by evaluating the long-term surgical outcomes of 25 consecutive cases. Medical records of 79 TCS cases which underwent surgery in Bakırköy Research and Training Hospital for Neurology, Neurosurgery and Psychiatry (BRSHH), during an 11-year period from 2005 to 2015, were retrospectively reviewed. All adult cases (patient age > 18 years) were selected as the core sample used for this study. Twenty-five cases of TCSs were surgically treated. The sample consists of 16 female and nine male patients. The mean age of the sample is 30.1 ± 10.3 years. Untethering was carried out in 88% of the patients. Sixty-four percent of the patients had good clinical outcomes at their last follow-up (after 73.8 months on average). The mean length of hospital stay was 4.76 ± 2.88 days. In a multivariate regression model, laminectomy, bladder dysfunction when associated to muscular weakness, and long-term (>6 months) symptoms were selected as the independent risk factors associated with poor or minimally improved (almost unchanged) surgical outcomes. When the urodynamic test showed overactive detrusor muscle, no improvement was recorded in postoperative urodynamic test. Laminoplasty (or hemilaminectomy), short-term (<6 months) symptoms, patients without lipomas, and presentation with moderate or mild symptoms seem to be proper predictors for good surgical outcomes. Further prospective studies are necessary to investigate these findings systematically. Urodynamic study can be used as a predictive tool for close follow-up of asymptomatic adult patients involved with TCS.
本研究旨在通过评估连续25例患者的长期手术效果，找出可能影响成人先天性脊髓栓系综合征（TCS）手术结果的因素。回顾性分析了2005年至2015年期间在巴克尔柯伊神经学、神经外科和精神病学研究与培训医院（BRSHH）接受手术的79例TCS患者的病历。所有成年病例（患者年龄>18岁）被选为该研究的核心样本。25例TCS患者接受了手术治疗。样本包括16名女性和9名男性患者。样本的平均年龄为30.1±10.3岁。88%的患者进行了脊髓松解术。64%的患者在最后一次随访时（平均73.8个月后）临床效果良好。平均住院时间为4.76±2.88天。在多变量回归模型中，椎板切除术、与肌无力相关的膀胱功能障碍以及长期（>6个月）症状被选为与手术效果差或改善甚微（几乎无变化）相关的独立危险因素。当尿动力学检查显示逼尿肌过度活跃时，术后尿动力学检查未记录到改善。椎板成形术（或半椎板切除术）、短期（<6个月）症状、无脂肪瘤的患者以及表现为中度或轻度症状似乎是手术效果良好的合适预测指标。有必要进行进一步的前瞻性研究来系统地调查这些发现。尿动力学研究可作为对无症状成年TCS患者进行密切随访的预测工具。
