Lin Hepu, Su Hui, Li Cuicui, Zhang Pengfei, Xiu Bo, Bai Yunjing, Xu Ruxiang
Department of Neurosurgery, The First Medical Center of the PLA General Hospital, Beijing, China.
Department of Neurosurgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China.
Front Surg. 2024 Jan 23;11:1277322. doi: 10.3389/fsurg.2024.1277322. eCollection 2024.
To study the classification, diagnosis, and treatment strategies of complex tethered cord syndrome (C-TCS) on the basis of the patients' clinical symptoms, imaging findings, and therapeutic schedule.
The clinical data of 126 patients with C-TCS admitted to our department from January 2015 to December 2020 were retrospectively analyzed. Classification criteria for C-TCS were established by analyzing the causes of C-TCS. Different surgical strategies were adopted for different types of C-TCS. The Kirollos grading, visual analogue scale (VAS), critical muscle strength, and Japanese Orthopaedic Association (JOA) scores were used to evaluate the surgical outcomes and explore individualized diagnosis and treatment strategies for C-TCS.
C-TCS was usually attributable to three or more types of tether-causing factors. The disease mechanisms could be categorized as pathological thickening and lipomatosis of the filum terminal (filum terminal type), arachnoid adhesion (arachnoid type), spina bifida with lipomyelomeningocele/meningocele (cele type), spinal lipoma (lipoma type), spinal deformity (bone type), and diastomyelia malformation (diastomyelia type). Patients with different subtypes showed complex and varied symptoms and required individualized treatment strategies.
Since C-TCS is attributable to different tether-related factors, C-TCS classification can guide individualized surgical treatment strategies to ensure complete release of the tethered cord and reduce surgical complications.
基于患者的临床症状、影像学表现及治疗方案，研究复杂型脊髓拴系综合征（C-TCS）的分类、诊断及治疗策略。
回顾性分析2015年1月至2020年12月我院收治的126例C-TCS患者的临床资料。通过分析C-TCS的病因建立其分类标准。针对不同类型的C-TCS采用不同的手术策略。采用基罗洛斯分级、视觉模拟评分法（VAS）、关键肌力及日本骨科学会（JOA）评分评估手术效果，探索C-TCS的个体化诊断和治疗策略。
C-TCS通常由三种或更多种导致拴系的因素引起。其发病机制可分为终丝病理性增厚和脂肪瘤形成（终丝型）、蛛网膜粘连（蛛网膜型）、伴脂肪瘤型脊髓脊膜膨出/脊膜膨出的脊柱裂（囊肿型）、脊髓脂肪瘤（脂肪瘤型）、脊柱畸形（骨型）及脊髓纵裂畸形（脊髓纵裂型）。不同亚型的患者表现出复杂多样的症状，需要个体化的治疗策略。
由于C-TCS由不同的拴系相关因素引起，C-TCS分类可指导个体化手术治疗策略，以确保脊髓拴系完全松解并减少手术并发症。
