Groen Rob J M, Lukassen Jertske N M, Boer Gert Jan, Vergeer Rob A, Coppes Maarten H, Drost Gea, Middel Berrie
Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
World Neurosurg. 2019 Mar;123:453-463.e15. doi: 10.1016/j.wneu.2018.11.229. Epub 2018 Dec 8.
Anterior thoracic spinal cord herniation (ATSCH) is a rare cause of progressive myelopathy. Early surgery is essential, but there is no agreement about the best surgical approach.
To identify factors that determine surgical results and to find evidence for the most favorable technique to correct ATSCH.
To find relevant literature, computed databases of PubMed, EMBASE, and ISI Web of Science were searched. The study comprised case reports published between 1974 and 2018, and the data set was completed with 12 cases treated in our own institute. Patient characteristics were analyzed following the principles of an individual participant data meta-analysis.
Brown-Séquard-like neurologic deficit before surgery was associated with postoperative motor function improvement compared with patients with paraparesis (P = 0.04). In the univariate analysis, widening of the dura defect (WDD) was more prevalent among improved patients, whereas anterior dura patch and application of intraoperative neurophysiologic monitoring were not. In the multivariate analysis, the favorable association with WDD disappeared, which is explained by the dominant influence of a Brown-Séquard-like deficit on outcome.
In general, postoperative results after surgery for ATSCH are favorable, with a high percentage of patients experiencing postoperative improvement. Postoperative motor function improvement is more likely to occur in patients with a Brown-Séquard-like neurologic deficit. The WDD should be favored above the application of a patch as the technique of choice in surgical treatment of ATSCH.
胸段脊髓前侧疝（ATSCH）是进行性脊髓病的罕见病因。早期手术至关重要，但对于最佳手术入路尚无共识。
确定决定手术效果的因素，并寻找纠正ATSCH最有利技术的证据。
为查找相关文献，检索了PubMed、EMBASE和ISI Web of Science的计算机数据库。该研究纳入了1974年至2018年间发表的病例报告，并以我们自己研究所治疗的12例病例完善数据集。按照个体参与者数据荟萃分析的原则分析患者特征。
与截瘫患者相比，术前类似布朗 - 色夸综合征的神经功能缺损与术后运动功能改善相关（P = 0.04）。在单因素分析中，硬脊膜缺损扩大（WDD）在病情改善的患者中更为常见，而硬脊膜前修补片和术中神经生理监测的应用则不然。在多因素分析中，与WDD的有利关联消失，这可以用类似布朗 - 色夸综合征的缺损对预后的主导影响来解释。
总体而言，ATSCH手术后的术后效果良好，术后病情改善的患者比例很高。类似布朗 - 色夸综合征神经功能缺损的患者术后更有可能出现运动功能改善。在ATSCH的手术治疗中，作为首选技术，应优先选择WDD而非应用修补片。
