McVeigh Luke G, Anokwute Miracle C, Belal Ahmed, Raman Natasha V, Zieles Kristin, Szymanski Konrad M, Misseri Rosalia, Jea Andrew
1Section of Pediatric Neurosurgery, Department of Neurological Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis.
2Section of Pediatric Urology, Department of Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana; and.
J Neurosurg Pediatr. 2021 May 7;28(1):3-12. doi: 10.3171/2020.11.PEDS20847. Print 2021 Jul 1.
Tethered cord syndrome (TCS) is a clinical and radiographic diagnosis of pathological stretching of the spinal cord leading to progressive loss of neurological function. The gold standard treatment for TCS is a tethered cord release. However, detethering involves significant risks of spinal cord injury and high rates of retethering. To mitigate these risks, the concept of spinal column shortening (SCS) to decrease spinal cord tension has become an alternative to detethering. In this study, the authors applied SCS to a pediatric and emerging adult population affected by secondary TCS.
A retrospective review of a prospective database at the authors' tertiary pediatric institution was performed. The Pediatric Quality of Life Inventory, patient- and parent-reported outcomes, and urodynamics were used to evaluate the outcomes of TCS treated with SCS.
A total of 41 patients with secondary TCS were treated with SCS. The average age at the time of surgery was 15.9 years (range 5-55 years). Preoperative symptoms evaluated included pain (33 patients), weakness (30 patients), and bladder/bowel dysfunction (39 patients). The most common level of spinal column osteotomy was T12, with spinal fusion between T10 and L2. The mean follow-up time was 22.6 months (range 8-45 months). For patients with at least 12 months of follow-up, subjective clinical improvements were reported in 21/23 (91.3%) of those with preoperative pain (p < 0.01); in 16/24 (66.7%) of patients with weakness (p < 0.01), and in 15/29 (51.7%) of those with bladder/bowel dysfunction (p < 0.01). The median differences in initial and most recent Pediatric Quality of Life Inventory results were +5 for patient-reported scores (n = 19, p = 0.04) and +5 for parent-reported scores (n = 19, p = 0.08). Formal urodynamics performed at a median of 3.5 months after surgery documented stable to improved bladder function in 16/17 patients, with a median improvement in one classification category (n = 17, p = 0.01).
SCS continues to represent a safe and efficacious alternative to traditional spinal cord untethering for TCS in children and emerging adults, as documented by objective formal urodynamics and patient- and parent-reported outcomes.
脊髓拴系综合征（TCS）是一种基于临床和影像学表现的诊断，指脊髓发生病理性牵拉，导致神经功能进行性丧失。TCS的金标准治疗方法是脊髓拴系松解术。然而，松解术存在脊髓损伤的重大风险以及较高的再拴系发生率。为降低这些风险，脊柱缩短术（SCS）这一旨在减轻脊髓张力的概念已成为拴系松解术的替代方案。在本研究中，作者将SCS应用于受继发性TCS影响的儿童及初显成年人群体。
对作者所在三级儿科机构的前瞻性数据库进行回顾性分析。使用儿童生活质量量表、患者及家长报告的结果以及尿动力学检查来评估采用SCS治疗TCS的效果。
共有41例继发性TCS患者接受了SCS治疗。手术时的平均年龄为15.9岁（范围5 - 55岁）。评估的术前症状包括疼痛（33例患者）、无力（30例患者）以及膀胱/肠道功能障碍（39例患者）。最常进行脊柱截骨的节段是T12，脊柱融合节段为T10至L2。平均随访时间为22.6个月（范围8 - 45个月）。对于随访至少12个月的患者，术前有疼痛的患者中，21/23（91.3%）报告有主观临床改善（p < 0.01）；无力患者中，16/24（66.7%）有改善（p < 0.01）；膀胱/肠道功能障碍患者中，15/29（51.7%）有改善（p < 0.01）。患者报告的儿童生活质量量表初始结果与最近结果的中位数差异为 +5（n = 19，p = 0.04），家长报告的结果中位数差异为 +5（n = 19，p = 0.08）。术后中位时间3.5个月进行的正式尿动力学检查显示，16/17例患者的膀胱功能稳定或改善，分类类别中位数改善一项（n = 17，p = 0.01）。
客观的正式尿动力学检查以及患者和家长报告的结果表明，对于儿童及初显成年人群体的TCS，SCS仍是一种安全有效的替代传统脊髓松解术的方法。
