Borgstedt-Bakke Joel Haakon, Wichmann Thea Overgaard, Gudmundsdottir Gudrun, Rasmussen Mikkel Mylius
J Neurosurg Pediatr. 2020 May 29;26(3):269-274. doi: 10.3171/2020.4.PEDS19722. Print 2020 Sep 1.
The goal of this study was to establish an incidence and assess the effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele.
The study population was based on the Western Denmark Myelomeningocele Database, which contains all patients born with myelomeningocele in western Denmark since 1970. The study population was cross-referenced in 2015 with a database for surgical procedures containing all surgical procedures performed in the central Denmark region since 1996. Patients alive between 1996 and 2015 were identified. Incidences was calculated and presented for year of age. File reviews were conducted for all patients who underwent the procedure. Follow-up was divided into short-term and long-term follow-up.
One hundred sixty-six patients were alive during various time periods between 1996 and 2015. Of these, 45 patients underwent the procedure. Seven underwent reoperation. The median age for the procedure was 12 years and the highest incidence was found at 15 years of age. Incidence was bimodal with highest incidence in children and adolescents. The most common indications were progressive spine deformity (40%), deteriorating ambulation (38%), and deteriorating neurogenic bladder and/or bowel dysfunction (32%). The mean short-term follow-up was 4.7 months and the mean long-term follow-up was 72.6 months. Postoperatively, the majority had improved (27%) or stabilized (27%) at short-term follow-up. At long-term follow-up, most patients were stable (27%) or had deteriorated (24%). For both follow-up terms there was a loss of approximately one-third of all patients. Complications occurred in 17% of the procedures.
In this population-based study, tethered cord release has the highest incidence in children and adolescents. The beneficial effect of the procedure seems to be short term. Due to the uncertainty of a long-term effect of the procedure in patients with myelomeningocele and the registered complications, the authors suggest that this surgical indication should be reserved for well-selected patients.
本研究的目的是确定脊髓脊膜膨出患者脊髓栓系松解术的发生率，并评估其效果。
研究人群基于丹麦西部脊髓脊膜膨出数据库，该数据库包含自1970年以来在丹麦西部出生的所有脊髓脊膜膨出患者。2015年，研究人群与一个手术程序数据库进行了交叉比对，该数据库包含自1996年以来在丹麦中部地区进行的所有手术程序。确定了1996年至2015年间存活的患者。计算并列出了各年龄段的发病率。对所有接受该手术的患者进行了档案审查。随访分为短期和长期随访。
1996年至2015年间的不同时间段有166名患者存活。其中，45名患者接受了该手术。7名患者接受了再次手术。该手术的中位年龄为12岁，最高发病率出现在15岁。发病率呈双峰分布，儿童和青少年发病率最高。最常见的指征是进行性脊柱畸形（40%）、步行能力恶化（38%）以及神经源性膀胱和/或肠道功能障碍恶化（32%）。平均短期随访为4.7个月，平均长期随访为72.6个月。术后，大多数患者在短期随访中病情有所改善（27%）或稳定（27%）。在长期随访中，大多数患者病情稳定（27%）或恶化（24%）。在两个随访期内，所有患者中约有三分之一失访。17%的手术出现了并发症。
在这项基于人群的研究中，脊髓栓系松解术在儿童和青少年中的发病率最高。该手术的有益效果似乎是短期的。由于脊髓脊膜膨出患者手术长期效果的不确定性以及已记录的并发症，作者建议该手术指征应仅用于精心挑选的患者。
