Saha Rahul, Chatterjee Sandip
DNBNeurosurgery, MNAMS(Neurosurgery),FRCS(SN), VIMS and Park Clinic, Kolkata, India.
Childs Nerv Syst. 2021 Jan;37(1):195-202. doi: 10.1007/s00381-020-04774-5. Epub 2020 Jul 8.
Adults rarely present with tethered cord syndrome, and this review examines whether it is justifiable to perform surgical intervention in this group.
Between 2003 and 2017, we performed surgical intervention in 32 adults with tethered cord syndrome. The age range varied from 22 to 65 years. Twenty-six had pain, 20 had motor deficits, and 18 had sensory deficits, whereas 17 presented with sphincter disturbances. Three had undergone surgery for meningomyelocele as infants. Six patients had major spinal deformity in the shape of kyphosis or scoliosis. All patients underwent digital radiographs and MR scans of the whole spine. The oldest with a leaking open meningocele was 41 years old.
The mean follow-up was 3.2 years. Twenty-one out of 26 patients presenting with pain had their VAS scores improve significantly; 14 had motor deficits which improved. However, sensory deficits got better in only 7 out of 18 patients, and sphincter improvement was documented (via urodynamics studies and bladder ultrasound) in only 4 out of 17 patients. In 15 cases, surgery was performed under neurophysiological monitoring, and overall improvement was documented in 11 of these patients compared with 7 of the remaining 17 patients. Surgery for spinal deformity was performed in 6 patients, and deformity correction as well as pain reduction was achieved in all.
Surgery leads to significant reduction of pain by untethering and in those with spinal deformity by correction of the same. Improvement in sensory changes and sphincter problems occurred in few patients. Neuromonitoring certainly has improved our results.
成人很少出现脊髓栓系综合征，本综述探讨了对该群体进行手术干预是否合理。
2003年至2017年间，我们对32例成人脊髓栓系综合征患者进行了手术干预。年龄范围为22至65岁。26例有疼痛，20例有运动功能障碍，18例有感觉功能障碍，而17例有括约肌功能障碍。3例在婴儿期因脊髓脊膜膨出接受过手术。6例患者有脊柱后凸或脊柱侧凸等严重脊柱畸形。所有患者均接受了全脊柱数字X线摄影和磁共振成像扫描。年龄最大的开放性脊髓脊膜膨出伴脑脊液漏患者为41岁。
平均随访3.2年。26例有疼痛的患者中，21例视觉模拟评分显著改善；14例有运动功能障碍的患者有所改善。然而，18例有感觉功能障碍的患者中只有7例好转，17例有括约肌功能障碍的患者中只有4例（通过尿动力学研究和膀胱超声检查）有改善记录。15例手术在神经生理监测下进行，这些患者中有11例总体情况改善，其余17例患者中只有7例改善。6例患者接受了脊柱畸形手术，均实现了畸形矫正和疼痛减轻。
手术通过松解脊髓栓系可显著减轻疼痛，对脊柱畸形患者通过矫正畸形也可减轻疼痛。少数患者的感觉变化和括约肌问题有所改善。神经监测确实改善了我们的手术效果。
