1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
2Weill Cornell Medical College, Cornell University, New York, New York.
J Neurosurg Pediatr. 2024 Oct 4;34(6):610-618. doi: 10.3171/2024.9.PEDS24277. Print 2024 Dec 1.
The objective of this study was to characterize pediatric patients with tight filum terminale (TFT) or fatty filum terminale (FFT) who experienced retethering after transection of the filum, and to determine the risk factors for retethering.
A systematic review was conducted on May 31, 2023, using PubMed, Google Scholar, SCOPUS, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies detailing retethering following transection for TFT or FFT. Studies were then screened using the Newcastle-Ottawa Scale for risk of bias assessment.
Eleven articles met the inclusion criteria with an overall cohort of 1167 patients evaluated for retethering following transection for TFT or FFT. The combined retethering rate across all retrospective studies was 3.4% (95% CI 1.6%-5.2%). A random-effects model was used to estimate the prevalence of presenting symptoms, with the most common being lower-extremity weakness in the overall cohort (54.5%, 95% CI 32.6%-76.4%) and bowel or bladder dysfunction in the retethered cohort (57.9%, 95% CI 41.1%-74.8%). Patients who experienced retethering had a similar estimated prevalence of low-lying conus (71.1%, 95% CI 45.1%-97.1%) compared with the overall cohort (51.1%, 95% CI 39.3%-63.0%). The most common complication following surgery for the overall cohort was a wound complication (2.7%, 95% CI 0.8%-4.6%). Postoperative CSF leakage (OR 13.8, 95% CI 3.9-49.4) was a strong predictor of retethering. Sensory changes at initial presentation were also found to be a predictor of retethering (OR 2.9, 95% CI 1.3-6.5). Low-lying conus was not predictive of retethering.
Preoperative sensory changes and postsurgical CSF leakage were associated with an increased retethering rate following transection of the filum in cases of tethered cord syndrome secondary to fatty filum terminale.
本研究旨在描述因终丝脂肪变（FFT）或终丝紧张（TFT）而行终丝切断术后发生再拴系的患儿，并确定再拴系的危险因素。
2023 年 5 月 31 日，我们按照系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）指南，在 PubMed、Google Scholar、SCOPUS 和 Web of Science 数据库中进行了系统综述，以确定详细描述 TFT 或 FFT 行终丝切断术后再拴系的研究。然后，我们使用纽卡斯尔-渥太华量表对风险偏倚进行了筛选。
共有 11 篇文章符合纳入标准，对 1167 例因 TFT 或 FFT 而行终丝切断术后发生再拴系的患者进行了评估。所有回顾性研究的再拴系率为 3.4%（95%CI，1.6%-5.2%）。我们使用随机效应模型估计了首发症状的患病率，在整个队列中，最常见的症状是下肢无力（54.5%，95%CI，32.6%-76.4%），在再拴系组中为肠或膀胱功能障碍（57.9%，95%CI，41.1%-74.8%）。与整个队列（51.1%，95%CI，39.3%-63.0%）相比，发生再拴系的患者低位圆锥的估计患病率相似（71.1%，95%CI，45.1%-97.1%）。整个队列中最常见的手术并发症是伤口并发症（2.7%，95%CI，0.8%-4.6%）。术后 CSF 漏（OR，13.8，95%CI，3.9-49.4）是再拴系的强预测因素。初始表现时的感觉变化也被发现是再拴系的预测因素（OR，2.9，95%CI，1.3-6.5）。低位圆锥并不能预测再拴系。
在因终丝脂肪变所致的脊髓栓系综合征行终丝切断术后，术前感觉变化和术后 CSF 漏与再拴系率增加相关。
