Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
Department of Pediatric surgery, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
Childs Nerv Syst. 2024 Nov;40(11):3703-3708. doi: 10.1007/s00381-024-06537-y. Epub 2024 Jul 17.
The objective of this study was to evaluate the prevalence of tethered cord among patients in the postoperative period of open and occult spina bifida. To identify warning signs for its early diagnosis, as well as outcomes after the new surgical approach.
Retrospective study of patients followed at the Pediatric Neurosurgery Department of the Federal University of São Paulo with spinal dysraphism. Signs and symptoms indicating reoperation were collected, and postoperative results were classified as improved, unchanged, or worsened.
222 medical records of patients diagnosed with spinal dysraphism were evaluated. Symptomatic Tethered Cord Syndrome (STCS) was identified in 30 patients (13.51%), with clinical manifestations related to orthopedic deformities (66.7%), neurological deficits (56.7%), urological dysfunction (50%), and intestinal dysfunction (40%). 20 cases underwent surgery for tethered cord release. The mean age at the time of surgery was 7.7 ± 4.9 years, with 13 female patients (65%). In the postoperative evaluation, improvement in low back pain (90.9%), urological pattern, and urinary tract infection episodes (45.4%) were particularly noteworthy. 3 patients (33.3%) with constipation showed improvement, and one worsened (11.1%). Improvement in ambulation was seen in two cases (16.7%). Low back pain was the first symptom to improve after surgery, with an average time of 1.3 months, followed by changes in the urological pattern at 15.6 months. Improvement in constipation was observed in the first month in 2 cases (66.7%), positive changes in ambulation were observed around 7 months after surgery, and only one case showed improvement in clubfoot correction.
The prevalence of tethered cord recurrence after primary correction surgery for open or occult neural tube closure defects was similar to that found in the literature. The results were encouraging, with good postoperative evolution of patients, especially in the improvement of low back pain and urological symptoms.
本研究旨在评估显性和隐性脊柱裂患者术后发生脊髓栓系的患病率。旨在确定早期诊断的预警信号以及新手术方法的术后结果。
对在圣保罗联邦大学儿科神经外科接受脊柱裂治疗的患者进行回顾性研究。收集提示需要再次手术的体征和症状，并将术后结果分为改善、不变或恶化。
共评估了 222 例诊断为脊柱裂的患者的病历。30 例（13.51%）患者存在症状性脊髓栓系综合征（STCS），临床表现与骨科畸形（66.7%）、神经功能缺损（56.7%）、尿功能障碍（50%）和肠道功能障碍（40%）相关。20 例患者接受了脊髓栓系松解术。手术时的平均年龄为 7.7±4.9 岁，其中女性 13 例（65%）。在术后评估中，腰痛（90.9%）、尿流模式和尿路感染发作（45.4%）的改善尤为明显。3 例（33.3%）便秘患者有所改善，1 例（11.1%）恶化。2 例（16.7%）的行走能力有所改善。腰痛是手术后第一个改善的症状，平均时间为 1.3 个月，其次是尿流模式在 15.6 个月时改变。2 例（66.7%）的便秘在第一个月得到改善，2 例（66.7%）的行走能力在手术后 7 个月左右出现阳性变化，仅 1 例足内翻矫正得到改善。
开放性或隐性神经管闭合缺陷初次矫正手术后脊髓栓系复发的发生率与文献报道相似。结果令人鼓舞，患者术后恢复良好，尤其是腰痛和尿功能症状得到改善。
