Jackson Christina, Yang Brian W, Bi Wenya Linda, Chiocca E Antonio, Groff Michael W
Department of Neurosurgery, Johns Hopkins Medical School, Baltimore, Maryland, USA.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2018 Apr;112:205-208. doi: 10.1016/j.wneu.2018.01.165. Epub 2018 Feb 1.
Adult tethered cord syndrome is a rare neurologic disorder that classically presents with back or leg pain, weakness, and urinary dysfunction. Spinal cord tethering has been associated with acquired Chiari malformations. Whereas the effects of tethered cord release on Chiari malformation symptoms have been described previously, we report an unusual case of acquired tethered cord syndrome following Chiari decompression.
We report a 68-year-old man with a history of distant T12-level spinal cord injury and 2 weeks of progressive bilateral lower extremity weakness. The patient underwent a T12-L1 laminectomy in 1977, complicated by arachnoiditis and syringomyelia, with eventual placement of a syringopleural shunt. He remained neurologically stable until 2012, when he underwent a suboccipital craniectomy for Chiari decompression for new-onset headache and dysphagia. Ten days later, the patient noted progressive leg weakness and radiographic evidence of spinal cord tethering at the T11-T12 level. A T10-L1 laminectomy and medical facetectomy was undertaken for detethering with postoperative recovery of ambulatory function with assistance.
Our patient exhibited an unusual acquisition of tethered cord syndrome. The tethering of the spinal cord may have been triggered by arachnoid adhesions from initial lumbar surgery 35 years before presentation and subsequently exacerbated by alterations of cerebrospinal fluid dynamics after Chiari decompression. Given the potentially devastating sequelae of tethered cord syndrome, investigation of cerebrospinal fluid flow dynamics may be beneficial before operative intervention in patients with risk factors for a tethered cord who exhibit adult-onset Chiari malformation.
成人脊髓拴系综合征是一种罕见的神经系统疾病，典型表现为背痛或腿痛、无力及排尿功能障碍。脊髓拴系与后天性Chiari畸形有关。虽然此前已描述过脊髓拴系松解对Chiari畸形症状的影响，但我们报告了一例Chiari减压术后发生后天性脊髓拴系综合征的罕见病例。
我们报告一名68岁男性，有T12水平脊髓损伤史，且出现进行性双侧下肢无力2周。该患者于1977年接受T12 - L1椎板切除术，并发蛛网膜炎和脊髓空洞症，最终置入脊髓胸膜分流管。他的神经功能一直稳定，直到2012年，因新发头痛和吞咽困难接受枕下颅骨切除术以进行Chiari减压。10天后，患者出现进行性腿部无力，影像学显示T11 - T12水平脊髓拴系。遂行T10 - L1椎板切除术及医源性关节突切除术以松解拴系，术后在辅助下恢复了行走功能。
我们的患者表现出一种不寻常的后天性脊髓拴系综合征。脊髓拴系可能由35年前初次腰椎手术导致的蛛网膜粘连引发，随后因Chiari减压后脑脊液动力学改变而加重。鉴于脊髓拴系综合征可能带来毁灭性后果，对于有脊髓拴系风险因素且出现成人期Chiari畸形的患者，在手术干预前研究脑脊液流动动力学可能有益。
