Tabanli Alper, Akcay Emrah, Yilmaz Hakan, Ozdemir Seymen, Mete Mesut, Selcuki Mehmet
Department of Neurosurgery, Izmir Tinaztepe University, Faculty of Medicine, Izmir, Turkey.
Department of Neurosurgery, University of Health Sciences, Faculty of Medicine, Izmir State Hospital, Izmir, Turkey.
Childs Nerv Syst. 2024 Dec 13;41(1):47. doi: 10.1007/s00381-024-06713-0.
Tethered cord syndrome (TCS) typically presents with urologic symptoms and abnormal imaging findings. However, some patients present with normal conus medullaris level and filum terminale appearance on MRI. This research seeks to assess the intended surgical results in this particular group of TCS patients who do not present with urologic complaints, under the premise that the surgical approach goes a long way in preventing the onset of urologic abnormalities.
This retrospective study included 59 operated patients with tethered cord syndrome who had a normal level terminating conus medullaris and a normal looking filum terminale without urologic symptoms. Of these patients, 38 were female and 21 were male. All patients underwent somatosensory-evoked potentials (SSEPs), and magnetic resonance imaging (MRI). The surgical technique used was flavotomy, which involves cutting the filum terminale without performing a laminectomy.
The study population had a mean age of 22.5 years (SD = 13.2). During the mean postoperative follow-up period of 2.5 years, none of the patients developed urinary incontinence. Preoperative SSEP abnormalities included conduction block in 39 patients (66.1%), low amplitude in 12 patients (20.3%), and delayed N22 wave latency in 8 patients (13.5%). The surgical procedures were completed without morbidity or mortality, and all patients showed significant postoperative improvement in SSEP parameters.
Our results indicate that even though the filum terminale might have a normal looking MRI, TCS can also occur due to some potential microscopic or structural abnormality. The study proves SSEP to be useful in TCS diagnosis and it also proposes that if surgery is done early before any urologic complaints arise, chances of their onset will be minimized. Such findings support the view that surgical measures should be entertained in symptomatic patients with abnormal SSEP but normal MRI.
脊髓拴系综合征（TCS）通常表现为泌尿系统症状和异常影像学表现。然而，一些患者在MRI上显示圆锥终丝水平和终丝外观正常。本研究旨在评估这一特殊组无泌尿系统症状的TCS患者的手术预期效果，前提是手术方式对预防泌尿系统异常的发生有很大作用。
这项回顾性研究纳入了59例接受手术治疗的脊髓拴系综合征患者，这些患者圆锥终丝水平正常、终丝外观正常且无泌尿系统症状。其中，女性38例，男性21例。所有患者均接受了体感诱发电位（SSEP）和磁共振成像（MRI）检查。采用的手术技术是黄韧带切开术，即不进行椎板切除术而切断终丝。
研究人群的平均年龄为22.5岁（标准差=13.2）。在平均2.5年的术后随访期内，没有患者出现尿失禁。术前SSEP异常包括39例（66.1%）传导阻滞、12例（20.3%）波幅降低和8例（13.5%）N22波潜伏期延迟。手术过程顺利，无并发症或死亡发生，所有患者术后SSEP参数均有显著改善。
我们的结果表明，即使终丝在MRI上外观正常，TCS也可能由于一些潜在的微观或结构异常而发生。该研究证明SSEP在TCS诊断中有用，并且还提出如果在出现任何泌尿系统症状之前早期进行手术，其发生的几率将降至最低。这些发现支持了对于SSEP异常但MRI正常的有症状患者应考虑采取手术措施的观点。
