Wen Haitao,Wu Tian,Chen Chaohui,et al.Efficacy comparison of unilateral intervertebral approach through small incision for the treatment of filamentous tether syndrome in children with normal conus position versus low conus position[J].Journal of Clinical Pediatric Surgery,,21():663-667.[doi:10.3760/cma.j.cn101785-202105001-013]
Efficacy comparison of unilateral intervertebral approach through small incision for the treatment of filamentous tether syndrome in children with normal conus position versus low conus position
- Keywords:
- Neural Tube Defects; Spinal Cord Compression; Neurosurgical Procedures/CL; Cauda Equina; Child
- Abstract:
- Objective To compare the difference of postoperative efficacy between children with normal conus position and those with reduced conus position in tethered cord syndrome.Methods From April 2017 to October 2020, retrospective analysis of clinical data was performed for 56 cases of filum terminale in tethered spinal cord.Clinical symptoms, imaging data and postoperative outcomes were recorded.All operations were successful without obvious postoperative complications.χ2 test revealed a significant inter-group difference in clinical manifestations of sacral tail skin lesions (χ2=6.890, P=0.009).No difference existed in clinical manifestations of defecation, urination dysfunction, lumbago or lower limb sensory/motor abnormalities and the difference was not statistically significant.Comparative analysis of auxiliary examination.Results Indicated that no significant inter-group differences existed in terminus tension, bladder residual urine volume, anorectal manometry or bilateral lower extremity sensory evoked potential.No significant inter-group difference existed in postoperative efficacy.A comparative analysis of postoperative auxiliary examination revealed that no significant abnormalities existed in improvement rate of bladder residual urine volume, anorectal pressure measurement or bilateral extremity sensory evoked potential between two groups.There was no statistical significance.Conclusion Cone position in children with tether syndrome has no relationship with the severity of neurological impairment and postoperative recovery.However, the number of cases is small in this group.And more cases are required for further verifications.
References:
[1] Yamada S, Iacono RP, Andrade T, et al.Pathophysiology of tethered cord syndrome[J].Neurosurg Clin N Am, 1995, 6(2):311-323.
[2] Yamada S, Won DJ.What is the true tethered cord syndrome?[J].Childs Nerv Syst, 2007, 23(4):371-375.DOI:10.1007/s00381-006-0276-3.
[3] 修波.脊髓纵裂诊治中的常见问题及对策[J].临床小儿外科杂志, 2019, 18(2):84-87.DOI:10.3969/j.issn.1671-6353.2019.02.002.Xiu B.Common problems and countermeasures in the diagnoses and treatment of split cord malformations[J].J Clin Ped Sur, 2019, 18(2):84-87.DOI:10.3969/j.issn.1671-6353.2019.02.002.
[4] 鲍南.先天性脊柱裂近期分类及手术治疗现状[J].中华小儿外科杂志, 1999, 20(4):57-59.Bao N.Recent classifications and surgical treatments of congenital spina bifida[J].Chin J Pediatr Surg, 1999, 20(4):57-59.
[5] Park JH, Hyun SJ.Intraoperative neurophysiological monitoring in spinal surgery[J].World J Clin Cases, 2015, 3(9):765-773.DOI:10.12998/wjcc.v3.i9.765.
[6] Scott SM, Carrington EV.The London classification:improving characterization and classification of anorectal function with anorectal manometry[J].Curr Gastroenterol Rep, 2020, 22(11):55.DOI:10.1007/s11894-020-00793-z.
[7] Lee TT, Arias JM, Andrus HL, et al.Progressive posttraumatic myelomalacic myelopathy:treatment with untethering and expansive duraplasty[J].J Neurosurg, 1997, 86(4):624-628.DOI:10.3171/jns.1997.86.4.0624.
[8] Finn MA, Walker ML.Spinal lipomas:clinical spectrum, embryology, and treatment[J].Neurosurg Focus, 2007, 23(2):E10.DOI:10.3171/FOC-07/08/E10.
[9] Al-Omari MH, Eloqayli HM, Qudseih HM, et al.Isolated lipoma of filum terminale in adults:MRI findings and clinical correlation[J].J Med Imaging Radiat Oncol, 2011, 55(3):286-290.DOI:10.1111/j.1754-9485.2011.02266.x.
[10] 张万盛, 王振维.脊柱与脊髓相关发育研究[J].大连医学院学报, 1983, 5(1):1-4, 11.Zhang WS, Wang ZW.Correlated development studies of spine and cord[J].Journal of Dalian Medical College, 1983, 5(1):1-4, 11.
[11] 王瑞, 张秀兰, 张魁亨, 等.胎儿脊椎脊髓发育观察[J].解剖学杂志, 1998, 21(3):229-232.Wang R, Zhang XL, Zhang KT, et al.Development observations of fetal spine and cord[J]. Chinese Journal of Anatomy, 1998, 21(3):229-232.
[12] Saker E, Henry BM, Tomaszewski KA, et al.The filum terminale internum and externum:A comprehensive review[J].Journal of Clinical Neuroscience, 2017, 40:6-13.DOI:10.1016/j.jocn.2016.12.020.
[13] Mottet N, Martinovic J, Baeza C, et al.Think of the conus medullaris at the time of diagnosis of fetal sacral agenesis[J].Fetal Diagn Ther, 2017, 42(2):137-143.DOI:10.1159/000451080.
[14] Schneider SJ, Rosenthal AD, Greenberg BM, et al.A preliminary report on the use of laser-Doppler flowmetry during tethered spinal cord release[J].Neurosurgery, 1993, 32(2):214-218.DOI:10.1227/00006123-199302000-00010.
[15] Komagata M, Endo K, Nishiyama M, et al.Management of tight filum terminale[J].Minim Invasive Neurosurg, 2004, 47(1):49-53.DOI:10.1055/s-2003-812463.
[16] Khoury AE, Hendrick EB, McLorie GA, et al.Occult spinal dysraphism:clinical and urodynamic outcome after division of the filum terminale[J].J Urol, 1990, 144(2 Pt 2):426-429.DOI:10.1016/s0022-5347(17)39481-8.
Memo
收稿日期:2021-05-02。
基金项目:湖南省中医药科研计划项目（2020108）
通讯作者:吴水华,Email:292454021@qq.com