Fone P D, Vapnek J M, Litwiller S E, Couillard D R, McDonald C M, Boggan J E, Stone A R
Department of Urology, University of California School of Medicine, Davis, USA.
J Urol. 1997 Feb;157(2):604-9.
We retrospectively reviewed 39 patients with a tethered spinal cord to evaluate whether surgical release positively influenced urological symptoms or urodynamic findings.
The patients were divided into 2 groups: group 1-11 with occult spinal dysraphism and group 2-28 with secondary spinal cord tethering after previous closure of a myelomeningocele or resection of a lipomyelomeningocele. Diagnosis was confirmed in all cases by magnetic resonance imaging or spinal ultrasound. A comprehensive urodynamic evaluation was done immediately preoperatively and 2 to 21 months (mean 7) postoperatively.
In group 1 the most common preoperative urodynamic finding was hyperreflexia, which improved or resolved after untethering in 62.5% of the patients. Four adults also reported improved bladder sensation or decreased urgency. In group 2 the most common urodynamic finding was impaired compliance, followed closely by detrusor hyperreflexia. Urodynamic patterns of detrusor hyperreflexia or compliance improved in only 30% of the patients, while 48% had worsened patterns. Only 14% of group 2 had improved symptoms of urinary control but 28% had improved lower extremity function.
Urological symptoms and urodynamic patterns may be improved by early surgical intervention in patients with occult spinal dysraphism. However, untethering did not consistently benefit patients with secondary spinal cord tethering.
我们回顾性研究了39例脊髓拴系患者，以评估手术松解是否对泌尿系统症状或尿动力学检查结果产生积极影响。
患者分为两组：第1组11例，患有隐性脊柱裂；第2组28例，在先前的脊髓脊膜膨出修补术或脂肪瘤型脊髓脊膜膨出切除术之后继发脊髓拴系。所有病例均通过磁共振成像或脊柱超声确诊。术前即刻及术后2至21个月（平均7个月）进行了全面的尿动力学评估。
在第1组中，术前最常见的尿动力学检查结果是反射亢进，62.5%的患者在松解术后有所改善或消失。4名成年人还报告膀胱感觉改善或尿急减轻。在第2组中，最常见的尿动力学检查结果是顺应性受损，其次是逼尿肌反射亢进。仅30%的患者逼尿肌反射亢进或顺应性的尿动力学模式有所改善，而48%的患者尿动力学模式恶化。第2组中只有14%的患者排尿控制症状有所改善，但28%的患者下肢功能有所改善。
对于患有隐性脊柱裂的患者，早期手术干预可能改善泌尿系统症状和尿动力学模式。然而，松解术并非对继发脊髓拴系的患者都有持续益处。
