Neurosurgery Department, Mashhad University of Medical Sciences, Mashhad, Iran.
Br J Neurosurg. 2022 Oct;36(5):574-582. doi: 10.1080/02688697.2021.1995589. Epub 2021 Oct 28.
Despite the evident clinical, neurological, orthopedic, and urodynamic dysfunctions, neuroanatomic imaging is normal in patients with occult tethered cord syndrome (OTCS). Therefore, the diagnosis of OTCS can be very complex. In this regard, this systematic review aimed to determine the main clinical features (i.e. neurological, musculoskeletal, and urological abnormalities) and improvement rates of these symptoms in patients with OTCS after the section of the filum terminale (SFT).
All the papers published in three electronic databases, namely Google Scholar, PubMed, and Web of Science, were searched for the purposes of this study. The searching process started on 15 October and lasted until 9 November 2020. Eventually, 10 reports were found about the clinical outcomes of SFT for the management of the OTCS.
The included studies were carried out on a total of 234 patients with OTCS, all of whom had undergone SFT. Evaluation of urologic symptoms revealed that 40-100% of patients with OTCS suffered from urinary instability. Moreover, its improvement rate after SFT was estimated at 59-100%. Evaluation of neurological symptoms indicated that 25-69% of patients with OTCS suffered from back/leg pain, And its improvement rate, the symptoms of back/leg pain of all patients were resolved or improved after SFT. Lower extremity weakness was found in 9-40% of patients with OTCS which was resolved or improved after SFT in about 25-100% of patients. Nevertheless, surgical indications for occult tight filum terminale syndrome remain controversial.
Although it seems that the SFT in OTCS patients is promising in treating neurologic, orthopedic and urological symptoms, usage of surgical untethering for patients with OTCS is a controversial issue. Clinical evaluation and urodynamic testing can be used to identify patients with OTCS. However, a multidisciplinary diagnostic work-up is strongly recommended for every child with OTCS.
尽管隐匿性脊髓栓系综合征（OTCS）患者存在明显的临床、神经、骨科和尿动力学功能障碍，但神经解剖影像学检查正常。因此，OTCS 的诊断可能非常复杂。在这方面，本系统评价旨在确定 OTCS 患者终丝切断术后（SFT）主要临床特征（即神经、骨骼肌肉和泌尿系统异常）及其症状改善率。
本研究检索了 Google Scholar、PubMed 和 Web of Science 三个电子数据库中发表的所有论文。检索过程于 2020 年 10 月 15 日开始，持续至 11 月 9 日。最终，发现了 10 篇关于 SFT 治疗 OTCS 临床结果的报告。
纳入的研究共纳入 234 例 OTCS 患者，均接受了 SFT。对泌尿系统症状的评估显示，40%-100%的 OTCS 患者存在尿失禁。此外，其 SFT 后改善率估计为 59%-100%。对神经症状的评估表明，25%-69%的 OTCS 患者存在背痛/腿痛，其 SFT 后改善率为所有患者的背痛/腿痛症状均得到缓解或改善。下肢无力见于 9%-40%的 OTCS 患者，SFT 后约 25%-100%的患者得到缓解或改善。然而，隐匿性紧终丝综合征的手术适应证仍存在争议。
尽管 SFT 似乎对治疗 OTCS 患者的神经、骨科和泌尿系统症状有一定疗效，但对 OTCS 患者使用手术松解仍存在争议。临床评估和尿动力学检查可用于识别 OTCS 患者。然而，强烈建议对每一位 OTCS 患儿进行多学科诊断性评估。
