Furst Taylor, Allegakoen Jayden, Jalal Muhammad I, Singh Rohin, Stone Jonathan J
Neurological Surgery, University of Rochester Medical Center, Rochester, USA.
Cureus. 2024 Nov 11;16(11):e73440. doi: 10.7759/cureus.73440. eCollection 2024 Nov.
A syrinx involves cystic dilation of the central canal of the spinal cord due to the accumulation of cerebrospinal fluid and often results in a neurological deficit. While treatment options vary, surgical management is often utilized and requires an open durotomy. A 70-year-old female presented with one year of progressive low back pain with associated leg numbness, urinary incontinence, bilateral foot drop, and imbalance resulting in multiple falls. MRI revealed a terminal syrinx at the level of the conus medullaris. She underwent an uncomplicated T12-L1 laminectomy for syrinx fenestration and syringo-subarachnoid shunt placement, resulting in improved bladder/bowel function, strength, sensation, and ambulation. The necessary midline durotomy was closed with a running 6-0 prolene suture fastened at the start and end of the suture line with the novel use of the COR-KNOT MICRO device (LSI Solutions, Victor, New York, US). We present the successful surgical management of a progressively symptomatic terminal syrinx using a syringo-subarachnoid shunt and the novel use of the COR-KNOT MICRO titanium fastener device for dural closure. Earlier shunting should be considered in the disease course of terminal syrinx, and the successful novel use of a titanium fastener on the dura warrants further investigation.
脊髓空洞症是由于脑脊液积聚导致脊髓中央管囊性扩张，常导致神经功能缺损。虽然治疗方案各不相同，但手术治疗经常被采用，且需要进行开放性硬脊膜切开术。一名70岁女性因进行性下背痛伴腿部麻木、尿失禁、双侧足下垂及失衡导致多次跌倒达一年之久前来就诊。磁共振成像（MRI）显示在脊髓圆锥水平有终末脊髓空洞症。她接受了简单的T12 - L1椎板切除术以进行脊髓空洞开窗和脊髓空洞 - 蛛网膜下腔分流术置入，术后膀胱/肠道功能、肌力、感觉及行走能力均有所改善。必要的中线硬脊膜切开术使用6 - 0普理灵缝线连续缝合，并在美国纽约维克多市的LSI Solutions公司生产的COR - KNOT MICRO器械的创新性使用下，于缝线两端固定。我们展示了使用脊髓空洞 - 蛛网膜下腔分流术成功手术治疗进行性有症状的终末脊髓空洞症，以及在硬脊膜闭合中创新性使用COR - KNOT MICRO钛质固定器械的情况。在终末脊髓空洞症的病程中应考虑早期分流，且在硬脊膜上成功创新性使用钛质固定器值得进一步研究。
