Lin Weiwei, Xu Hongtao, Duan Guman, Xie Jinjin, Chen Yisheng, Jiao Baohua, Lan Haitao
a Department of Neurosurgery , Second Hospital of Hebei Medical University , Shijiazhuang , China.
b Department of Orthopedics , Third Hospital of Hebei Medical University , Shijiazhuang , China.
Neurol Res. 2018 May;40(5):340-363. doi: 10.1080/01616412.2018.1446268. Epub 2018 Mar 12.
Purpose Tethered cord syndrome (TCS) is the clinical manifestation of an abnormal stretch on the spinal cord, caused by several pathological conditions. Tethered cord release is the gold standard treatment for TCS. However, direct untethering carries potential risks of spinal cord injury, post-operative retethering, and CSF-related complications. Spine-shortening osteotomy (SSO) has recently been performed as an alternative technique to avoid these risks. We aimed to systematically review the literature on indications and outcome of SSO in TCS patients. Methods We searched PubMed, Embase, Google Scholar, and the Cochrane Library to identify all studies on SSO in TCS patients. We used random or fixed-effects models to calculate rates and 95% confidence intervals to establish the rates of clinical improvement in TCS patients performed with SSO. Sensitive analysis and metaregression were made to explore potential sources of heterogeneit. Results We identified six eligible surveys with a total population of 57. Rates ranged from 62 to 88% for neurological deficits improvement, 80-100% for motor function improvement, 60-96% for pain or numbness scores improvement, 13-67% for sensory function improvement, and 79-100% for urinary and bowel dysfunction improvement. We noted substantial heterogeneity in rate estimates for motor function and urinary and bowel dysfunction improvement (all Cochran's χ² significant at P < 0.001; I² = 78.11%, 95%CI 61-94%; 84.28%, 18-100%; respectively). Conclusion SSO is a safe and effective technique for TCS patients, especially in more challenging cases, such as complex malformations or revision surgery. However, future cohort studies and randomized studies with large numbers and the power to provide illumination for the surgical decision-making of TCS are warranted.
目的 脊髓拴系综合征（TCS）是由多种病理状况导致脊髓受异常牵拉的临床表现。脊髓拴系松解术是TCS的金标准治疗方法。然而，直接松解存在脊髓损伤、术后再拴系及脑脊液相关并发症的潜在风险。脊柱缩短截骨术（SSO）近来已作为一种避免这些风险的替代技术应用。我们旨在系统回顾关于TCS患者行SSO的适应证及疗效的文献。方法 我们检索了PubMed、Embase、谷歌学术和Cochrane图书馆，以识别所有关于TCS患者行SSO的研究。我们使用随机或固定效应模型计算发生率及95%置信区间，以确定行SSO的TCS患者的临床改善率。进行敏感性分析和Meta回归以探索异质性的潜在来源。结果 我们确定了6项符合条件的调查，总共有57例患者。神经功能缺损改善率为62%至88%，运动功能改善率为80%至100%，疼痛或麻木评分改善率为60%至96%，感觉功能改善率为13%至67%，排尿和排便功能障碍改善率为79%至100%。我们注意到运动功能以及排尿和排便功能障碍改善率估计值存在显著异质性（所有 Cochr an检验χ²在P < 0.001时具有显著性；I²分别为78.11%，95%CI 61 - 94%；84.28%，18 - 100%）。结论 SSO对于TCS患者是一种安全有效的技术，尤其是在更具挑战性的病例中，如复杂畸形或翻修手术。然而，未来需要进行大量的队列研究和随机研究，以有足够的能力为TCS的手术决策提供依据。
