Lee Ji Yeoun, Kim Kyung Hyun, Park Kwanjin, Wang Kyu-Chang
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.
Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2020 May;63(3):346-357. doi: 10.3340/jkns.2020.0039. Epub 2020 Apr 27.
During the follow-up period after surgery for spinal dysraphism, a certain portion of patients show neurological deterioration and its secondary phenomena, such as motor, sensory or sphincter changes, foot and spinal deformities, pain, and spasticity. These clinical manifestations are caused by tethering effects on the neural structures at the site of previous operation. The widespread recognition of retethering drew the attention of medical professionals of various specialties because of its incidence, which is not low when surveillance is adequate, and its progressive nature. This article reviews the literature on the incidence and timing of deterioration, predisposing factors for retethering, clinical manifestations, diagnosis, surgical treatment and its complications, clinical outcomes, prognostic factors after retethering surgery and preventive measures of retethering. Current practice and opinions of Seoul National University Children's Hospital team were added in some parts. The literature shows a wide range of data regarding the incidence, rate and degree of surgical complications and long-term outcomes. The method of prevention is still one of the main topics of this entity. Although alternatives such as spinal column shortening were introduced, re-untethering by conventional surgical methods remains the current main management tool. Re-untethering surgery is a much more difficult task than primary untethering surgery. Updated publications include strong skepticism on re-untethering surgery in a certain group of patients, though it is from a minority of research groups. For all of the abovementioned reasons, new information and ideas on the early diagnosis, treatment and prevention of retethering are critically necessary in this era.
在脊柱裂手术后的随访期间，一部分患者会出现神经功能恶化及其继发现象，如运动、感觉或括约肌改变、足部和脊柱畸形、疼痛和痉挛。这些临床表现是由先前手术部位对神经结构的牵拉作用引起的。由于再牵拉的发生率（在充分监测时并不低）及其进行性，它得到了各专业医学专家的广泛关注。本文综述了有关恶化的发生率和时间、再牵拉的易感因素、临床表现、诊断、手术治疗及其并发症、临床结果、再牵拉手术后的预后因素以及再牵拉的预防措施等方面的文献。部分内容补充了首尔国立大学儿童医院团队的当前实践和观点。文献显示，关于手术并发症的发生率、比率和程度以及长期结果的数据范围很广。预防方法仍然是该领域的主要话题之一。尽管引入了诸如脊柱缩短等替代方法，但通过传统手术方法进行再次松解仍然是当前的主要治疗手段。再次松解手术比初次松解手术困难得多。最新的出版物对特定患者群体的再次松解手术提出了强烈质疑，尽管这只是少数研究小组的观点。基于上述所有原因，在这个时代，关于再牵拉的早期诊断、治疗和预防的新信息和新观点至关重要。
