Department of Neurosurgery, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Acta Neurochir (Wien). 2022 Jun;164(6):1473-1480. doi: 10.1007/s00701-022-05218-6. Epub 2022 Apr 28.
The purpose of this study was to evaluate outcome following surgical transection of filum terminale (FT) in symptomatic and asymptomatic pediatric patients with radiological findings consistent with tethered cord syndrome (TCS).
Patients < 17 years who underwent untethering surgery between 2007 and 2018 were screened for eligibility. Those who had undergone primary transection of the FT, and had preoperative radiological findings of fatty filum, thickened FT, or low-lying conus, below the pedicles of L2, were included. The cohort was divided into symptomatic and asymptomatic depending on clinical presentation. Surgical complications and functional outcome was recorded.
In total, 95 patients were included, of whom 62 were symptomatic. In symptomatic patients, the main indications for radiological evaluation were scoliosis (29%) and motor symptoms (19%). In asymptomatic patients, skin stigmata (76%) were the most common finding. Fatty or thick FT was the most common radiographic finding, seen in 61% of symptomatic and 79% of asymptomatic cases. All patients underwent transection of the FT and were followed for a median of 1.8 years. A postoperative complication occurred in 12%, all Ibanez type Ib and managed without invasive treatment. For the symptomatic cohort, significant improvement was seen for both urodynamic assessment (48% improved, p = 0.002) and sensorimotor function (42% improved, p < 0.001).
Neurological improvement or halted deterioration was seen in the majority of symptomatic cases. Asymptomatic patients did not experience any severe complications. Filum transection should be offered to symptomatic and asymptomatic patients upon diagnosis of fatty filum, thickened FT, or low-lying conus.
本研究旨在评估影像学表现符合脊髓栓系综合征（TCS）的有症状和无症状儿科患者行终丝切断术后的结果。
筛选了 2007 年至 2018 年间接受松解手术的<17 岁患者，以评估其是否符合入选标准。纳入标准为：行终丝初次切断术，术前影像学检查提示脂肪终丝、终丝增粗或圆锥低位，低于 L2 椎弓根。根据临床表现将患者分为有症状组和无症状组。记录手术并发症和功能结局。
共纳入 95 例患者，其中 62 例有症状。在有症状患者中，影像学评估的主要指征为脊柱侧凸（29%）和运动症状（19%）。在无症状患者中，皮肤体征（76%）最常见。脂肪或增粗的终丝是最常见的影像学表现，在有症状和无症状患者中分别占 61%和 79%。所有患者均行终丝切断术，中位随访时间为 1.8 年。12%的患者发生术后并发症，均为 Ibanez Ⅰb 型，无需侵入性治疗。对于有症状组，尿动力学评估（48%改善，p=0.002）和感觉运动功能（42%改善，p<0.001）均有显著改善。
大多数有症状患者的神经功能得到改善或停止恶化。无症状患者未发生严重并发症。对于影像学提示脂肪终丝、终丝增粗或圆锥低位的有症状和无症状患者，建议行终丝切断术。
