Tani S, Nakahara S, Tanaka H, Kanki T, Noda Y, Abe T
Department of Neurosurgery, Jikei University School of Medicine.
No Shinkei Geka. 1994 Dec;22(12):1131-4.
The neurological deficits caused by tethered cord syndrome do not necessarily follow a dermatomal pattern of the affected spinal cord from caudal to cephalic fashion. The authors defined these neurological deficits as "skip lesions", and reviewed the neurological deficits in tethered cord syndrome. Among 29 cases, inconsecutive segmental motor weakness in 3 cases, inconsecutive segmental sensory impairment in 6 cases, positive Babinski reflex in 8 cases, supranuclear neurogenic bladder in 3 cases and lumbago or leg pain in 4 cases were observed and they were thought to be compatible with the neurological deficits called "skip lesions". The basic mechanism of this sign is that the cephalic portion of the spinal cord is functionally impaired during flexion of the lumbosacral spine, while the caudal spinal cord with decreased visco-elasticity dose not elongate. Inconsecutive motor-sensory disturbance, accelerated deep tendon reflexes in the lower extremities, positive Babinski or other pathological reflexes in the lower extremities, uninhibited neurogenic bladder, lumbago and pain in the legs were considered to belong to the category of "skip lesions" and they can be treated by the untethering procedure. The authors concluded that preoperative careful insight into the mechanism of "skip lesions" revealed surgical efficacy for the reversible neurological deficits by the untethering procedure, or the efficacy of decompression of the lipoma or neurolysis around the involved spinal nerve roots.
脊髓拴系综合征所致神经功能缺损并不一定遵循受累脊髓从尾端到头端的皮节模式。作者将这些神经功能缺损定义为“跳跃性损害”，并对脊髓拴系综合征中的神经功能缺损进行了回顾。在29例病例中，观察到3例节段性非连续性运动无力、6例节段性非连续性感觉障碍、8例巴氏征阳性、3例核上性神经源性膀胱以及4例腰痛或腿痛，这些被认为与“跳跃性损害”这一神经功能缺损相符。该体征的基本机制是，腰骶部脊柱屈曲时脊髓头端部分功能受损，而粘弹性降低的尾端脊髓无法伸长。节段性非连续性运动 - 感觉障碍、下肢深腱反射亢进、下肢巴氏征或其他病理反射阳性、神经源性膀胱不受抑制、腰痛和腿痛被认为属于“跳跃性损害”范畴，可通过松解手术进行治疗。作者得出结论，术前仔细洞察“跳跃性损害”的机制可揭示松解手术对可逆性神经功能缺损的手术疗效，或对脂肪瘤减压或受累脊神经根周围神经松解的疗效。
