Filum terminale transection in pediatric tethered cord syndrome: a single center, population-based, cohort study of 95 cases.
Filum terminale transection in pediatric tethered cord syndrome: a single center, population-based, cohort study of 95 cases.
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儿科脊髓栓系综合征的终丝横断：单中心、基于人群的 95 例队列研究。
DOI：
10.1007/s00701-022-05218-6
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发表时间：
2022-06
影响因子：
2.4
通讯作者：
Sandvik, Ulrika
中科院分区：
文献类型：
--
作者：
Edstrom, Erik;Wesslen, Charlotte;Fletcher-Sandersjoo, Alexander;Elmi-Terander, Adrian;Sandvik, Ulrika
本研究的目的是评估有症状和无症状的小儿脊髓栓系综合征（TCS）患者手术切除终丝（FT）的结果。对2007年至2018年期间接受解绑手术的患者进行了资格筛选。那些接受过原发性椎弓根横断，术前影像学发现有脂肪丝、增厚的椎弓根或L2椎弓根下的低位圆锥的患者被纳入研究。该队列根据临床表现分为有症状和无症状。记录手术并发症和功能结局。共纳入95例患者，其中62例有症状。在有症状的患者中，放射学评估的主要指征是脊柱侧凸（29%）和运动症状（19%）。在无症状的患者中，皮肤红斑（76%）是最常见的发现。脂肪或厚FT是最常见的x线表现，在61%的有症状病例和79%的无症状病例中可见。所有患者均行FT横切术，随访时间中位数为1.8年。术后并发症发生率为12%，均为Ib型Ibanez，且未进行侵入性治疗。对于有症状的队列，尿动力学评估（改善48%，p = 0.002）和感觉运动功能（改善42%，p < 0.001）均有显著改善。在大多数有症状的病例中可以看到神经系统改善或停止恶化。无症状患者未出现严重并发症。对于有症状和无症状的患者，在诊断为脂肪丝、增厚的FT或低处圆锥时，应进行丝横断。
The purpose of this study was to evaluate outcome following surgical transection of filum terminale (FT) in symptomatic and asymptomatic pediatric patients with radiological findings consistent with tethered cord syndrome (TCS). Patients < 17 years who underwent untethering surgery between 2007 and 2018 were screened for eligibility. Those who had undergone primary transection of the FT, and had preoperative radiological findings of fatty filum, thickened FT, or low-lying conus, below the pedicles of L2, were included. The cohort was divided into symptomatic and asymptomatic depending on clinical presentation. Surgical complications and functional outcome was recorded. In total, 95 patients were included, of whom 62 were symptomatic. In symptomatic patients, the main indications for radiological evaluation were scoliosis (29%) and motor symptoms (19%). In asymptomatic patients, skin stigmata (76%) were the most common finding. Fatty or thick FT was the most common radiographic finding, seen in 61% of symptomatic and 79% of asymptomatic cases. All patients underwent transection of the FT and were followed for a median of 1.8 years. A postoperative complication occurred in 12%, all Ibanez type Ib and managed without invasive treatment. For the symptomatic cohort, significant improvement was seen for both urodynamic assessment (48% improved, p = 0.002) and sensorimotor function (42% improved, p < 0.001). Neurological improvement or halted deterioration was seen in the majority of symptomatic cases. Asymptomatic patients did not experience any severe complications. Filum transection should be offered to symptomatic and asymptomatic patients upon diagnosis of fatty filum, thickened FT, or low-lying conus.
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影响因子：
4.3
作者：
Kasliwal, Manish K.;Mahapatra, Ashok K.
通讯作者：
Mahapatra, Ashok K.
影响因子：
1.4
作者：
Usami, Kenichi;Lallemant, Pauline;Zerah, Michel
通讯作者：
Zerah, Michel
影响因子：
1.4
作者：
Wykes, Victoria;Desai, Divyesh;Thompson, Dominic N. P.
通讯作者：
Thompson, Dominic N. P.
DOI：
10.21037/jss.2019.09.02
发表时间：
2019-09-01
期刊：
Journal of spine surgery (Hong Kong)
影响因子：
--
作者：
Bhimani, Abhiraj D;Selner, Ashley N;Mehta, Ankit I
通讯作者：
Mehta, Ankit I
影响因子：
2
作者：
Landriel Ibanez, Federico Alfonso;Hem, Santiago;Carrizo, Antonio
通讯作者：
Carrizo, Antonio