Occult tethered cord syndrome: a survey of practice patterns
Occult tethered cord syndrome: a survey of practice patterns
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DOI：
10.3171/ped.2006.104.5.309
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发表时间：
2006-05-01
影响因子：
4.1
通讯作者：
Gupta, Nalin
中科院分区：
文献类型：
--
作者：
Steinbok, Paul;Garton, Hugh J. L.;Gupta, Nalin
Object.脊髓栓系综合征（TCS）与许多涉及脊髓早期发育的先天性异常有关。包括脊髓脊膜膨出、脊髓脂肪瘤、低位脊髓圆锥和纤维脂肪终丝。隐匿性TCS发生在临床特征表明TCS但缺乏典型解剖异常的患者中。对于以前没有发现解剖异常的患者，手术松解终丝是否会导致临床改善仍有争议。为了评估执业小儿神经外科医生使用的临床标准，在2004年美国神经外科医生协会/神经外科医生大会小儿神经外科联合分会年会上进行了一项实践调查。该调查检查了在同一病例情况下，影像学检查表现不同的临床决策。对于有症状、低位脊髓圆锥和脂肪终丝的患者的诊断和治疗有明确的共识。绝大多数受访者（85%）赞成对该患者进行手术松解。大多数受访者（67%）也赞成对有症状和脂肪终丝的患者进行治疗。然而，在一名有症状的患者中，关于疾病的诊断和治疗存在重大分歧，磁共振成像研究结果不确定。一些受访者明确支持手术，而另一些人认为，该患者不符合TCS的诊断标准。这项调查的结果支持随机临床试验的发展，以解决隐匿性TCS手术的好处。
Object. Tethered cord syndrome (TCS) is associated with a number of congenital anomalies involving early development of the spinal cord. These include myelomeningocele, spinal cord lipoma, low-lying conus medullaris, and a fibrofatty terminal filum. Occult TCS occurs in patients when clinical features indicate a TCS but the typical anatomical abnormalities are lacking. It is controversial whether surgical release of the terminal filum leads to clinical improvement in a patient who does not have a previously identified anatomical abnormality. To assess the clinical standard used by practicing pediatric neurosurgeons, a practice survey was conducted at the 2004 Annual Meeting of the Joint Section for Pediatric Neurological Surgery of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.Methods. The survey examined clinical decision making for a same-case scenario with differing appearance on imaging studies. There was a clear consensus regarding diagnosis and treatment in the patient with symptoms, a low-lying conus medullaris, and a fatty terminal filum. The vast majority of respondents (85%) favored surgical untethering for this patient. A majority of respondents (67%) also favored treatment for the patient having symptoms and a fatty terminal filum. There was, however, significant disagreement regarding the diagnosis and treatment of disease in one patient with symptoms and an inconclusive magnetic resonance imaging study. Some respondents clearly favored surgery, whereas others believed that this patient did not meet the diagnostic criteria for TCS.Conclusions. The results of this survey support the development of a randomized clinical trial to address the benefit of surgery for occult TCS.