Symptomatic Retethering of the Spinal Cord After Section of a Tight Filum Terminale
Symptomatic Retethering of the Spinal Cord After Section of a Tight Filum Terminale
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DOI：
10.1227/neu.0b013e31821246c6
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发表时间：
2011-06-01
期刊：
影响因子：
4.8
通讯作者：
Steinbok, Paul
中科院分区：
文献类型：
--
作者：
Yong, Raymund L.;Habrock-Bach, Tracey;Steinbok, Paul
背景：与用于更复杂的脊柱异常的脊髓松解手术相比，终丝切开是一种微创的手术方式。然而，坊间证据表明，由于瘢痕形成而导致的症状性复栓的风险可能比之前认为的更高。目的：确定紧致终丝切开后症状性复拴的频率，并探索可能的危险因素。方法：我们回顾了2个儿科神经外科中心的数据库，所有在1982年1月至2009年6月间因疑似紧致终丝进行手术的患者都进行了手术。中位随访期为78个月。13名患者(8.6%)在首次治疗后的中位时间为23.4个月，继续进行有症状的再拔管。8例早期复栓(2年内)，5例晚期复栓(7年后)。与晚期复栓者相比，早期复栓者初次手术时年龄较大(中位数9.4岁比0.9岁)，圆锥水平较高(中位数L1/L2比L3/L4)，初次手术后蛛网膜炎较多，需要更多重复解除栓系手术。晚期复栓者在初次手术时比未复栓者年轻(中位数为0.9岁对4.5岁)。结论：在简单的丝状剪断后，有症状的复栓者并不少见，长期随访是有必要的。观察到两种截然不同的复系模式。感染或脑脊液瘘引起的蛛网膜炎可能倾向于早期再栓系，而早期预防脊髓栓系症状的手术可能倾向于晚期再栓系。
BACKGROUND: Section of a tight filum terminale is a minimally invasive procedure compared with cord untethering procedures used for more complex spinal abnormalities. Anecdotal evidence suggests, however, that the risk of symptomatic retethering resulting from scarring might be higher than previously thought.OBJECTIVE: To determine the frequency of symptomatic retethering after section of a tight filum terminale and to explore possible risk factors.METHODS: We reviewed databases at 2 pediatric neurosurgery centers for all patients who had surgery for a suspected tight filum terminale between January 1982 and June 2009.RESULTS: We identified 152 patients. The median length of follow-up was 78 months. Thirteen patients (8.6%) went on to retether symptomatically at a median time of 23.4 months after the initial procedure. Eight had early retethering (within 2 years) and 5 had late retethering (after 7 years). Compared with late retetherers, early retetherers were older at initial surgery (median, 9.4 vs 0.9 years of age), had a higher level of the conus (median, L1/L2 vs L3/L4), had more arachnoiditis after initial surgery, and required more repeat untethering procedures. Late retetherers were younger at initial surgery than those who did not retether (median, 0.9 vs 4.5 years of age).CONCLUSION: Symptomatic retethering is not uncommon after a simple filum snip, and long-term follow-up is warranted. Two distinct patterns of retethering were observed. Arachnoiditis caused by infection or a cerebrospinal fluid fistula may predispose to early retethering, whereas early surgery for prevention of tethered cord symptoms may predispose to late retethering.