Telfeian Albert Edward, Punsoni Michael, Hofstetter Christoph P
Department of Neurosurgery, University of Washington, Seattle, WA, USA.
J Spine Surg. 2017 Jun;3(2):278-282. doi: 10.21037/jss.2017.06.10.
Tethered cord syndrome is a constellation of symptoms and signs that include back and leg pain, bowel and bladder dysfunction, scoliosis and lower extremity weakness and deformity. Tethering may be due to a tight filum terminale or a form of spinal dysraphism. The authors present a case of a 40-year-old man who presented with symptoms of back pain, bilateral lower extremity radicular pain, and bowel and bladder dysfunction. Magnetic resonance imaging showed a sacral lipomyelomeningocele, with fat tracking superiorly to the conus, which was tethered at the L4-L5 level. A minimally-invasive surgical approach with endoscopic visualization and identification of the nerve roots and filum terminale was performed. The patient's postoperative clinical course was uneventful. This case highlights two important issues. First, minimally invasive spine techniques should be considered in the surgical treatment of tethered cord especially given the theoretical advantages of minimizing pain, spinal fluid leakage, and subsequent scarring. And second, endoscopic techniques are advancing. In the case presented here, endoscopic visualization and operative techniques made identification and transection of the filum terminale possible through a tiny dural opening. The small dural opening could theoretically pose the advantage of decreasing the risk of spinal fluid leakage. Clinicians should be aware that endoscopic visualization and techniques can serve as minimally-invasive adjuncts to enhance the traditional approach to many surgical pathologies.
脊髓拴系综合征是一组症状和体征，包括背痛、腿痛、肠道和膀胱功能障碍、脊柱侧弯以及下肢无力和畸形。脊髓拴系可能是由于终丝紧张或某种形式的脊柱闭合不全所致。作者报告了一例40岁男性患者，其表现为背痛、双侧下肢神经根性疼痛以及肠道和膀胱功能障碍。磁共振成像显示为骶尾部脂肪瘤型脊髓脊膜膨出，脂肪向上延伸至圆锥，圆锥在L4-L5水平处被拴系。采用了在内镜可视化下识别神经根和终丝的微创外科手术方法。患者术后临床过程顺利。该病例突出了两个重要问题。首先，在脊髓拴系的外科治疗中应考虑微创脊柱技术，特别是鉴于其在减轻疼痛、脑脊液漏和后续瘢痕形成方面的理论优势。其次，内镜技术在不断发展。在此病例中，内镜可视化和手术技术通过一个微小的硬脊膜开口实现了终丝的识别和横断。理论上，小的硬脊膜开口可能具有降低脑脊液漏风险的优势。临床医生应意识到，内镜可视化和技术可作为微创辅助手段，以改进许多外科疾病的传统治疗方法。
