Dias Mark S, Wang Ming, Rizk Elias B, Bowman Robin, Partington Michael D, Blount Jeffrey P, Rocque Brandon G, Hopson Betsy, Ettinger Daria, Lee Amy, Walker William O
1Department of Neurosurgery, Penn State Hershey Children's Hospital and Penn State College of Medicine, Hershey.
2Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
J Neurosurg Pediatr. 2021 May 7;28(1):21-27. doi: 10.3171/2020.12.PEDS20868. Print 2021 Jul 1.
The aims of this study were to review the National Spina Bifida Patient Registry (NSBPR) data set to study the rates of tethered spinal cord release (TCR) among patients with myelomeningocele and variability between centers, to compare TCR rates between males and females, and to study the relationships between TCR rates and other condition-specific characteristics.
The NSBPR registry was queried to identify all patients with myelomeningocele. TCR rates were calculated over time using survival analyses; rates between centers and between males and females were compared. Cox proportional hazards models were constructed to identify relationships between TCR rates and sex, functional lesion level, ambulation status, treated hydrocephalus, and prior Chiari decompression.
Of 6339 patients with information about their operations, 1366 (21.5%) underwent TCR, with significant variability between centers. The majority (75.8%) underwent a single TCR. The annual TCR rate was linear between birth and 13 years (1.8%/year) but declined sharply from 14 to 21 years (0.7%/year). There was no period of time at which the TCR rate accelerated. There were no significant differences in TCR rates between males and females. TCR rate was not related to functional lesion level but was lower among nonambulators compared with community ambulators (p = 0.005) and among those with treated hydrocephalus (HR 0.30, p < 0.001), and higher among those having prior Chiari decompression (HR 1.71, p < 0.001).
These results extend the results of prior single-institution studies, demonstrate significant treatment variability between institutions, and challenge the traditional concept that tethering is related to spinal cord stretching due to spinal growth.
本研究旨在回顾国家脊柱裂患者登记处（NSBPR）数据集，以研究脊髓脊膜膨出患者的脊髓拴系松解术（TCR）发生率及各中心之间的差异，比较男性和女性的TCR发生率，并研究TCR发生率与其他特定病情特征之间的关系。
查询NSBPR登记处以识别所有脊髓脊膜膨出患者。使用生存分析计算随时间推移的TCR发生率；比较各中心之间以及男性和女性之间的发生率。构建Cox比例风险模型以确定TCR发生率与性别、功能性病变水平、行走状态、治疗的脑积水以及既往小脑扁桃体下疝减压术之间的关系。
在6339例有手术信息的患者中，1366例（21.5%）接受了TCR，各中心之间存在显著差异。大多数（75.8%）接受了单次TCR。出生至13岁期间的年TCR发生率呈线性（每年1.8%），但在14至21岁时急剧下降（每年0.7%）。没有TCR发生率加速的时间段。男性和女性的TCR发生率没有显著差异。TCR发生率与功能性病变水平无关，但与非行走者相比，社区行走者的TCR发生率较低（p = 0.005），治疗脑积水的患者中TCR发生率也较低（风险比0.30，p < 0.001），而既往有小脑扁桃体下疝减压术的患者中TCR发生率较高（风险比1.71，p < 0.001）。
这些结果扩展了先前单机构研究的结果，表明各机构之间治疗差异显著，并挑战了传统观念，即拴系与脊柱生长导致的脊髓拉伸有关。
