Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA.
Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
J Clin Neurosci. 2022 Apr;98:1-5. doi: 10.1016/j.jocn.2021.12.037. Epub 2022 Jan 31.
An abnormal or absent superficial abdominal reflex (SAR) may be associated with an underlying spinal cord syrinx. The sensitivity of an abnormal or absent SAR and the relationship to Chiari malformation type I (CM-I) or syrinx morphology has not been studied. We aimed to describe the relationship between SAR abnormalities and syrinx size, location, and etiology. Children who underwent brain or c-spine MRI over 11 years were reviewed in this retrospective cohort study. Patients with idiopathic and CM-I-associated syringes (axial diameter ≥ 3 mm) were included. Clinical examination findings (including SAR) and imaging characteristics were analyzed. Of 271 patients with spinal cord syrinx, 200 had either CM-I-associated or idiopathic syrinx, and 128 of these patients had SAR-evaluation documentation. Forty-eight percent (62/128) had an abnormal or absent reflex. Abnormal/absent SAR was more common in patients with CM-I-associated syrinx (61%) compared with idiopathic syrinx (22%) (P < 0.0001). Abnormal/absent SAR was associated with wider syringes (P < 0.001), longer syringes (P < 0.05), and a more cranial location of the syrinx (P < 0.0001). Controlling for CM-I, scoliosis, age, sex, cranial extent of syrinx, and syrinx dimensions, CM-I was independently associated with abnormal or absent SAR (OR 4.2, 95% CI 1.4-14, P < 0.01). Finally, the sensitivity of SAR for identifying a patient with syrinx was 48.1%. An abnormal/absent SAR was present in most patients with CM-I-associated syrinx but in a minority of patients with idiopathic syrinx. This has implications for pathophysiology of CM-I-associated syrinx and in guiding clinical care of patients presenting with syrinx.
腹壁浅反射异常或消失（SAR）可能与脊髓空洞症有关。异常或缺失的 SAR 的敏感性及其与 Chiari 畸形 I 型（CM-I）或空洞形态的关系尚未研究。我们旨在描述 SAR 异常与空洞大小、位置和病因之间的关系。在这项回顾性队列研究中，对 11 年来接受脑部或颈椎 MRI 检查的儿童进行了回顾。纳入了特发性和 CM-I 相关空洞（轴向直径≥3mm）患者。分析了临床检查结果（包括 SAR）和影像学特征。在 271 例脊髓空洞症患者中，200 例为 CM-I 相关或特发性空洞，其中 128 例有 SAR 评估记录。48%（62/128）存在反射异常或消失。CM-I 相关空洞患者异常/缺失 SAR 更为常见（61%），而特发性空洞患者则较少见（22%）（P<0.0001）。异常/缺失 SAR 与更宽的空洞（P<0.001）、更长的空洞（P<0.05）和空洞位置更靠近颅侧（P<0.0001）有关。控制 CM-I、脊柱侧凸、年龄、性别、空洞颅侧范围和空洞尺寸后，CM-I 与异常或缺失 SAR 独立相关（OR 4.2，95%CI 1.4-14，P<0.01）。最后，SAR 识别空洞患者的敏感性为 48.1%。CM-I 相关空洞患者中大多数存在异常/缺失 SAR，而特发性空洞患者中则较少见。这对 CM-I 相关空洞的病理生理学以及指导有空洞患者的临床护理具有重要意义。
