Endoscopic spinal tethered cord release: operative technique
Endoscopic spinal tethered cord release: operative technique
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DOI：
10.1007/s00381-008-0800-8
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发表时间：
2009-05-01
影响因子：
1.4
通讯作者：
Di, Xiao
中科院分区：
文献类型：
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作者：
Di, Xiao
本研究旨在描述用于治疗脊柱病理的内窥镜手术技术。在这里，我们提出了一种新的内窥镜技术的手术松解脊髓的细丝切片和讨论内窥镜手术管理的这个实体。两名患者（年龄8个月和10岁）的腿无力，大小便功能障碍，下背部和颈部疼痛，增厚，脂肪终丝。2例患者均采用0A度和30A度、直径4mm、长度18cm的硬式内窥镜行半椎板切除术。在内窥镜直视下硬膜内显微切割将脂肪丝送入硬脊膜切开处。进行电刺激，同时监测下肢和肛门括约肌的肌电图活动。在获得阳性对照后，通过缺乏括约肌和下肢肌电图反应来识别细丝，然后烧灼和切割。两例患者术前症状均明显改善，1例患者尿动力学异常和基亚里症状消失。该手术具有减少软组织损伤、减轻术后疼痛、减少失血、切口较小和缩短住院时间的优点。然而，内窥镜解栓技术是否能获得高于开放手术的益处，仍有待于对照研究确定。
This study aims to describe solely endoscopic surgical techniques for the treatment of spinal pathology. Here, we present a novel endoscopic technique for surgical untethering of the spinal cord by filum sectioning and discuss endoscopic surgical management of this entity.Two patients (ages 8 months and 10 years) presented with leg weakness, urine and bowel dysfunction, low back and neck pain, and thickened, fatty filum terminale. The elder patient presented with clinical incontinence and abnormal urodynamic studies.Both patients underwent a solely endoscopic approach using 0A degrees and 30A degrees, 4 mm in diameter and 18 cm in length rigid endoscopes via a hemilaminectomy. Intradural microdissection under a direct visualization of endoscope delivered the fatty filum into the durotomy. Electrical stimulation was performed while the lower extremities and the anal sphincter were monitored for electromyographic activity. After acquisition of positive controls, the filum was identified by the lack of sphincter and lower extremity electromyographic responses and was then cauterized and cut. Both patients had significant improvement of their preoperative symptoms, and one patient had resolution of the abnormal urodynamics and her Chiari symptoms.Tethered spinal cords can be safely and effectively untethered endoscopically. This procedure provides the advantages of reduced soft tissue injury, less postoperative pain, minimal blood loss, a smaller incision, and a shorter hospitalization. However, whether the endoscopic untethering technique achieves benefits above those associated with the open procedure remains to be determined by a control study.