Seki Toshitaka, Hida Kazutoshi, Yano Shunsuke, Houkin Kiyohiro
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan.
Asian Spine J. 2018 Jun;12(3):551-555. doi: 10.4184/asj.2018.12.3.551. Epub 2018 Jun 4.
A retrospective cohort study.
To examine the validity of prophylactic surgery for children with tethered cord syndrome (TCS).
Prophylactic surgery for pediatric patients with TCS remains controversial.
We retrospectively analyzed the surgical outcomes of 14 children (nine boys and five girls) with asymptomatic TCS who were surgically treated at Hokkaido University Hospital between 1989 and 2015.
The median age at the time of initial surgery for asymptomatic TCS was 28.6 months (range, 0-66 months). The median final follow-up period was 142 months (range, 7-232 months). Of the 14 children with asymptomatic TCS, 12 had lumbosacral lipoma and two had meningocele. According to the classification of spinal lipoma, two children had dorsal type, four had caudal type, two had transitional type, and four had filar type. There were no children with lipomyelomeningocele. All children were free of neurological symptoms until 94 months after the initial surgery. Subsequently, one child exhibited delayed neurological deficits and underwent a second surgery because of motor and sensory disturbances; slight sensory disturbance was noted at the final follow-up examination. Another child later showed bowel and bladder dysfunction. However, a second surgery was not performed for this child because his motor and sensory functions were normal; hence, we chose to avoid nerve injury in the case of dissecting adhesion.
All 14 children with asymptomatic TCS were free of neurological symptoms until 94 months after the initial surgery. However, two children exhibited delayed neurological deficits at 94 months and 177 months. We believe that prophylactic surgery for asymptomatic TCS is effective for a certain period. However, because the natural history of TCS is poorly understood, strict follow-up after surgery is necessary.
一项回顾性队列研究。
探讨脊髓拴系综合征（TCS）患儿预防性手术的有效性有效性有效性。
小儿TCS患者的预防性手术仍存在争议。
我们回顾性分析了1989年至2015年期间在北海道大学医院接受手术治疗的14例无症状TCS患儿（9例男孩和5例女孩）的手术结果。
无症状TCS初次手术时的中位年龄为28.6个月（范围0 - 66个月）。末次随访的中位时间为142个月（范围7 - 232个月）。14例无症状TCS患儿中，12例有腰骶部脂肪瘤，2例有脊膜膨出。根据脊髓脂肪瘤的分类，2例为背侧型，4例为尾侧型，2例为过渡型，4例为终丝型。无脂肪脊髓脊膜膨出患儿。所有患儿在初次手术后94个月内均无神经症状。随后，1例患儿出现延迟性神经功能缺损，因运动和感觉障碍接受了二次手术；末次随访检查时发现轻微感觉障碍。另1例患儿后来出现了肠道和膀胱功能障碍。然而，该患儿未进行二次手术，因为其运动和感觉功能正常；因此，在分离粘连时我们选择避免神经损伤。
14例无症状TCS患儿在初次手术后94个月内均无神经症状。然而，2例患儿分别在94个月和177个月时出现延迟性神经功能缺损。我们认为无症状TCS的预防性手术在一定时期内是有效的。然而，由于对TCS的自然病程了解不足，术后严格随访是必要的。
