Iskandar B J, Fulmer B B, Hadley M N, Oakes W J
Division of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.
J Neurosurg. 1998 Jun;88(6):958-61. doi: 10.3171/jns.1998.88.6.0958.
The management of tethered spinal cord syndrome with onset of symptomatology occurring in adulthood remains controversial, although the necessity of early surgery in the pediatric tethered cord syndrome population is well established. To ascertain the results of surgery in adult patients with this anomaly, the authors undertook a retrospective review of 34 cases.
The authors studied the hospital records of 34 consecutive patients who presented in adulthood with tethered cord syndrome and conducted follow-up phone interviews with 28 of them. The population consisted of 12 men and 22 women, ranging in age from 18 to 70 years (mean 34 years). The most common presenting feature was pain, followed by weakness and incontinence. All patients underwent surgery. The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies. Long-term surgical results and patient outcome ratings were encouraging. After a mean clinical follow-up period of 4 years, significant improvement occurred in 22 of 27 patients presenting with pain, 13 of 27 patients with motor or sensory dysfunction, and 11 of 18 patients with bowel and bladder disturbance. In addition, telephone interviews were obtained after a period of 8.6 years. Twenty-two (79%) of 28 patients called the operation a long-term success; 21 (75%) of 28 patients believed that they had significant postoperative improvement (and not just stabilization) in pain and/or neurological function. Surgical complications were generally minor. Nineteen (86%) of 22 employed patients returned to work after surgery. Two (33%) of six patients who were not employed before surgery worked full time postoperatively. Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work.
Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. Because neurological deficits are generally irreversible, early surgery is recommended.
尽管小儿脊髓拴系综合征早期手术的必要性已得到充分证实，但成年期出现症状的脊髓拴系综合征的治疗仍存在争议。为了确定成年患者手术治疗该病的效果，作者对34例患者进行了回顾性研究。
作者研究了34例成年期出现脊髓拴系综合征的连续患者的医院记录，并对其中28例进行了随访电话访谈。该人群包括12名男性和22名女性，年龄在18至70岁之间（平均34岁）。最常见的症状是疼痛，其次是无力和失禁。所有患者均接受了手术。最常见的手术发现是终丝紧张、脊髓纵裂畸形和脂肪瘤型脊髓脊膜膨出，与小儿研究中的发现相似。长期手术效果和患者预后评分令人鼓舞。平均临床随访4年后，27例疼痛患者中有22例有显著改善，27例运动或感觉功能障碍患者中有13例改善，18例肠道和膀胱功能障碍患者中有11例改善。此外，在8.6年后进行了电话访谈。28例患者中有22例（79%）称手术取得了长期成功；28例患者中有21例（75%）认为他们术后在疼痛和/或神经功能方面有显著改善（而非仅仅是稳定）。手术并发症一般较轻。22例就业患者中有19例（86%）术后重返工作岗位。术前未就业的6例患者中有2例（33%）术后全职工作。接受访谈的28例患者中只有2例获得了工伤赔偿；这2例患者预后良好并重返工作岗位。
成人脊髓拴系综合征是一种少见但会出现症状的疾病。虽然成人手术比儿童手术发生神经损伤的风险更高，但它是一种低风险手术，效果令人鼓舞。由于神经功能缺损通常是不可逆的，因此建议早期手术。
