Day Emily L, Proctor Mark R, Scott R Michael
J Neurosurg Pediatr. 2020 Apr 3;26(1):60-64. doi: 10.3171/2020.2.PEDS19743. Print 2020 Jul 1.
The aim of this study was to retrospectively review, from a single busy pediatric neurosurgical service, a consecutive series of patients who had undergone surgery for a simple tethered spinal cord, which was defined by a thickened or fatty filum terminale with a normal conus. The hope was to contribute to benchmark data regarding the expected frequency of surgery for this condition.
The authors reviewed the electronic medical records of every patient with diagnosed simple tethered spinal cord, defined on spinal MRI as a thickened (> 2 mm in diameter) or fatty filum terminale, and who had undergone primary filum section at Boston Children's Hospital between 2005 and 2011.
A total of 208 patients met the study inclusion criteria. At the time of surgery, patients ranged in age from 0.4 to 19.8 years. One hundred forty-four (69%) patients were symptomatic with one or more of the following: bowel/bladder dysfunction, 94 (45%); neurological dysfunction, 49 (24%); scoliosis, 44 (21%); or back pain, 44 (21%). Sixty-four (31%) patients were asymptomatic and were operated on prophylactically when filum pathology was discovered during the course of a workup for clinical syndromes such as anorectal anomalies and/or suspicious cutaneous lesions. No patients in this series were operated on if they had normal MRI studies, defined as a conus tip no lower than L3 and no distal tethering lesion visualized. Over the study period, approximately 1000 major surgical cases were performed in the department every year, only 30 of which were simple detethering procedures, representing well under 5% of the service's operative volume and approximately 5 cases per surgeon per year. Clinical follow-up, available at a postoperative interval of 6.6 ± 3.8 years, demonstrated that approximately 80% of patients symptomatic with bowel or bladder involvement or neurological dysfunction had improvement or relief of their symptoms and that none of the patients treated prophylactically experienced new-onset symptoms that could be related to spinal tethering.
Simple detethering procedures were relatively uncommon in an active, well-established pediatric neurosurgical service and represented less than 5% of the service's total case volume per year with an average of 5 cases per surgeon per year. No patients with normal MRI studies were operated on during the study period.
本研究旨在对一家繁忙的儿科神经外科中心连续收治的因单纯脊髓拴系而接受手术治疗的患者进行回顾性分析，单纯脊髓拴系定义为终丝增粗或脂肪化且圆锥正常。希望能为该疾病的预期手术频率提供基准数据。
作者回顾了2005年至2011年间在波士顿儿童医院接受初次终丝切断术的每例经脊髓磁共振成像（MRI）诊断为单纯脊髓拴系（定义为终丝直径增粗>2mm或脂肪化）患者的电子病历。
共有208例患者符合研究纳入标准。手术时，患者年龄范围为0.4至19.8岁。144例（69%）患者有以下一种或多种症状：肠道/膀胱功能障碍，94例（45%）；神经功能障碍，49例（24%）；脊柱侧弯，44例（21%）；或背痛，44例（21%）。64例（31%）患者无症状，在对诸如肛门直肠畸形和/或可疑皮肤病变等临床综合征进行检查过程中发现终丝病变后接受了预防性手术。如果MRI检查正常（定义为圆锥尖端不低于L3且未发现远端拴系病变），本系列中没有患者接受手术。在研究期间，该科室每年约进行1000例大手术，其中只有30例是单纯松解拴系手术，占该科室手术量的比例不到5%，每位外科医生每年约5例。术后6.6±3.8年的临床随访表明，约80%有肠道或膀胱受累或神经功能障碍症状的患者症状得到改善或缓解，且接受预防性治疗的患者均未出现与脊髓拴系相关的新发症状。
在一家活跃且成熟的儿科神经外科中心，单纯松解拴系手术相对少见，每年占该科室总病例量不到5%，每位外科医生每年平均5例。研究期间，MRI检查正常的患者未接受手术。
