Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China; Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China.
Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China.
World Neurosurg. 2024 May;185:e415-e420. doi: 10.1016/j.wneu.2024.02.040. Epub 2024 Feb 14.
This study compared the clinical therapeutic efficacy of syringo-subarachnoid shunt placement with direct tube and T-tube via the dorsal root entry zone (DREZ) approach for treatment of eccentric syringomyelia.
A retrospective study was performed of 41 patients with idiopathic or secondary eccentric syringomyelia from November 2011 to December 2022. Syringo-subarachnoid shunt placement with direct tube or T-tube via the DREZ approach was performed. The modified Japanese Orthopaedic Association low back pain scale was used to investigate the severity of clinical symptoms. Magnetic resonance imaging was used to investigate therapeutic efficacy（reduction of the cavity volume by >10% was considered an improvement and 50% was considered a significant improvement).
Incision length of the spinal cortex in the direct tube group was shorter than in the T-tube group (3.10 ± 0.28 cm vs. 5.03 ± 0.19 cm), with a significant difference between the 2 groups (t = -52.56, P < 0.001). Modified Japanese Orthopaedic Association score 3 months postoperatively was significantly better than the preoperative score in both the direct tube group（t = 40.954, P < 0.001） and the T-tube group（t = 24.769, P < 0.001）. Statistical comparison revealed there was no difference in imaging improvement between the direct tube group and T-tube group 3 months (χ = 0.20, P = 0.655) and 12 months (χ = 0.21, P = 0.647) postoperatively.
Syringo-subarachnoid shunt placement with direct tube via the DREZ approach for treatment of eccentric syringomyelia is safer than with T-tube via the DREZ approach due to smaller incision length and less of a space-occupying effect with same therapeutic efficacy.
本研究比较了经背根入区（DREZ）入路直接置管与 T 型管行脊髓蛛网膜下腔分流术治疗偏心性脊髓空洞症的临床疗效。
回顾性分析 2011 年 11 月至 2022 年 12 月收治的 41 例特发性或继发性偏心性脊髓空洞症患者。采用 DREZ 入路行直接置管或 T 型管脊髓蛛网膜下腔分流术。采用改良日本矫形协会下腰痛评分评估临床症状严重程度。磁共振成像（MRI）评估疗效（空洞体积减少>10%为改善，减少 50%为显著改善）。
直接置管组脊髓皮层切口长度短于 T 型管组（3.10±0.28cm 比 5.03±0.19cm），差异有统计学意义（t=-52.56，P<0.001）。术后 3 个月直接置管组和 T 型管组改良日本矫形协会评分均明显优于术前（t=40.954，P<0.001；t=24.769，P<0.001）。术后 3 个月和 12 个月，直接置管组和 T 型管组影像学改善差异均无统计学意义（χ2=0.20，P=0.655；χ2=0.21，P=0.647）。
经 DREZ 入路行直接置管脊髓蛛网膜下腔分流术治疗偏心性脊髓空洞症较 T 型管安全性更高，因切口较小，占位效应更小，且疗效相同。
