Moriarty Thomas M, Gump William C, Mutchnick Ian S, Comingore Joy, Daniels Michael, Peppas Dennis S, Rosenberg Eran, White Jeffrey T, Sizemore Erin R, Moeller Karen K
Divisions of1Pediatric Neurosurgery.
4Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Kentucky.
J Neurosurg Pediatr. 2025 Jun 27;36(3):330-342. doi: 10.3171/2025.2.PEDS24457. Print 2025 Sep 1.
There is significant evidence in the literature and decades of practice experience that support filum terminale sectioning as an effective intervention to improve the symptoms of simple tethered cord (sTC). The diagnosis of sTC and indications for sTC surgery vary widely across the US and Canada, although the overall incidence of sTC surgery has been increasing across the US. This study sought to create and evaluate an evidence-based algorithm for the management of sTC.
An institutional standard for sTC management was established, based on an evidence-based medicine analysis of 93 papers from the literature. A prospective, IRB-approved study of all patients treated with these strictly delimited indications in 2019 was undertaken. Demographic, clinical, diagnostic, consultative, and outcome data were collected for all patients. Operated patients were seen at 6 weeks and 6 months for follow-up. Postoperative outcomes were recorded on a 4-point ordinal scale (worse, same, better, resolved) for analysis.
Seven hundred twenty-nine unique patients were evaluated for possible sTC in 1 calendar year. One hundred fifty-one operations were performed. Two minor complications were noted (surgical wound breakdown and upper extremity deep vein thrombosis). All operated patients were clinically symptomatic, 79% of whom had 3 or more symptoms of sTC syndrome. Patients were seen by 3 or more subspecialists before surgery in 60% of the cases; no patient had fewer than 2 subspecialists involved in diagnosis. Postoperative results recorded by neurosurgery were strongly concordant with results observed by consultants. Significant improvement of symptomatic sTC was found across all symptoms (bladder/bowel/back pain/leg pain/gait/headache/tone) in the majority of patients.
Filum terminale release for patients with sTC is a low-morbidity, high-impact intervention that can be beneficial to many children. A standardized set of operative indications driven by a multidisciplinary, evidence-based algorithm for sTC had high accuracy in identifying patients who benefit from a filum terminale release.
文献中有大量证据以及数十年的实践经验支持终丝切断术作为改善单纯脊髓拴系（sTC）症状的有效干预措施。在美国和加拿大，sTC的诊断及sTC手术指征差异很大，尽管美国sTC手术的总体发生率一直在上升。本研究旨在创建并评估一种基于证据的sTC管理算法。
基于对93篇文献的循证医学分析，制定了sTC管理的机构标准。对2019年所有按照这些严格界定的指征进行治疗的患者进行了一项经机构审查委员会批准的前瞻性研究。收集了所有患者的人口统计学、临床、诊断、会诊及结局数据。接受手术的患者在术后6周和6个月进行随访。术后结局采用4级序贯量表（更差、相同、更好、缓解）记录以进行分析。
在1个日历年中，对729例可能患有sTC的患者进行了评估。共进行了151例手术。记录到2例轻微并发症（手术伤口裂开和上肢深静脉血栓形成）。所有接受手术的患者都有临床症状，其中79%有3种或更多sTC综合征症状。60%的病例中，患者在手术前由3名或更多亚专科医生诊治；没有患者的诊断涉及少于2名亚专科医生。神经外科记录的术后结果与会诊医生观察到的结果高度一致。大多数患者的所有症状（膀胱/肠道/背痛/腿痛/步态/头痛/肌张力）中，有症状的sTC均有显著改善。
对于sTC患者，终丝松解术是一种低发病率、高影响力的干预措施，可能对许多儿童有益。由多学科、基于证据的算法驱动的一套标准化手术指征在识别能从终丝松解术中获益的患者方面具有很高的准确性。
