Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty
Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty
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DOI：
10.1007/s00381-009-0895-6
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发表时间：
2009-09-01
影响因子：
1.4
通讯作者：
Jallo, George I.
中科院分区：
文献类型：
--
作者：
Samuels, Roger;McGirt, Matthew J.;Jallo, George I.
背景首次出现症状性脊髓栓系的患者在手术解除栓系后，可能会发生脊髓栓系和其他术后并发症。目前尚不清楚在初次手术中使用硬脑膜成形术与初次硬脑膜闭合术是否与术后即刻并发症或随后症状性再栓发生率降低相关。目前还不清楚不同的病因是否与每种缝合方法后的不同结局相关。我们回顾了我们的儿科经验，首次手术解除症状性脊髓栓系综合征（TCS），以确定术后并发症和症状性再栓系硬膜成形术后与一期closure.Materials和方法的发病率。在初次闭合后，复杂病因比非复杂病因更容易再栓（33.6% vs. 6.6%，p=0.05），但在硬脑膜成形术后则不然（13.7% vs. 5.4%，p=0.33）。硬脑膜成形术移植物类型（聚四氟乙烯与牛心包）与假性脑膜膨出或retethering.Conclusion在我们的经验中，观察到的症状性retetheringwith复杂的小儿TCS（pTCS）原发性硬脑膜关闭后，没有观察到硬脑膜成形术时，发病率增加。硬脑膜扩张成形术可能是有价值的，特别是在复杂的pTCS病因的患者亚组的管理。
Background Cord retethering and other postoperative complications can occur after the surgical untethering of a first-time symptomatic tethered cord. It is unclear if using duraplasty vs. primary dural closure in the initial operation is associated with decreased incidence of either immediate postoperative complications or subsequent symptomatic retethering. It is also unclear if different etiologies are associated with different outcomes after each method of closure. We reviewed our pediatric experience in first-time surgical untethering of symptomatic tethered cord syndrome (TCS) to identify the incidence of postoperative complications and symptomatic retethering after duraplasty vs. primary closure.Materials and methods We retrospectively reviewed 110 consecutive pediatric (0.05. Complex etiologies were more likely to retether than noncomplex etiologies after primary closure (33.6% vs. 6.6%, p=0.05) but not after duraplasty (13.7% vs. 5.4%, p=0.33). Duraplasty graft type (polytetrafluoroethylene vs. bovine pericardium) was not associated with pseudomeningocele or retethering.Conclusion In our experience, the increased rate of symptomatic retethering observed with complex pediatric TCS (pTCS) etiologies after primary dural closures was not observed when duraplasty was instituted. Expansile duraplasty may be valuable specifically in the management of patient subgroups with complex pTCS etiologies.