Schneider S J, Rosenthal A D, Greenberg B M, Danto J
Division of Neurosurgery, North Shore University Hospital, Manhasset, New York.
Neurosurgery. 1993 Feb;32(2):214-7; discussion 217-8. doi: 10.1227/00006123-199302000-00010.
Neurological deterioration in the tethered cord syndrome has been postulated to result from a compromise of blood flow in the distal spinal cord. In order to evaluate vascular perfusion in human subjects, a new technique of laser-Doppler flowmetry was used to monitor continuously the microcirculation of the distal spinal cord during surgery for tethered cord release in 10 children. For further comparison, five children undergoing selective dorsal rhizotomy were also monitored. In the tethered cord syndrome group, spinal cord blood flow before untethering was a mean of 12.6 ml/min per 100 g of tissue and increased in all cases after release to a mean of 29.4 ml/min per 100 g of tissue. All patients improved neurologically. The selective dorsal rhizotomy group had a preoperative mean spinal cord blood flow of 30.8 ml/min per 100 g of tissue, which was not altered by the operative procedure. Significant improvement occurs in distal spinal cord blood flow after tethered cord release, which may be representative of an important mechanism in the pathophysiology of the tethered cord syndrome.
脊髓拴系综合征的神经功能恶化被推测是由于脊髓远端血流受损所致。为了评估人体受试者的血管灌注情况，采用一种新的激光多普勒血流测定技术，对10例儿童进行脊髓拴系松解手术期间的脊髓远端微循环进行连续监测。为了进行进一步比较，还对5例接受选择性背根切断术的儿童进行了监测。在脊髓拴系综合征组中，松解前脊髓血流平均为每100克组织12.6毫升/分钟，松解后所有病例均增加，平均为每100克组织29.4毫升/分钟。所有患者神经功能均有改善。选择性背根切断术组术前脊髓血流平均为每100克组织30.8毫升/分钟，手术过程未使其改变。脊髓拴系松解后脊髓远端血流显著改善，这可能是脊髓拴系综合征病理生理学中的一个重要机制。
