Minimally invasive tethered cord release in adults: a comparison of open and mini-open approaches
Minimally invasive tethered cord release in adults: a comparison of open and mini-open approaches
复制标题
DOI：
10.3171/2010.3.focus1077
复制
发表时间：
2010-07-01
影响因子：
4.1
通讯作者：
Mummaneni, Praveen V.
中科院分区：
文献类型：
--
作者：
Potts, Matthew B.;Wu, Jau-Ching;Mummaneni, Praveen V.
物体。有症状的脊髓栓系和相关的异常，如脊髓纵裂，在成年期很少出现，但会导致严重的疼痛以及运动、感觉和膀胱功能障碍。与儿童一样，研究表明，手术剥离可能会改善疼痛和神经功能障碍。典型的手术治疗包括开腹椎板切除术、终丝切开和脊髓裂开畸形探查。然而，这种开放入路会造成严重的棘旁肌肉损伤和疤痕。微创技术的最新进展允许进入脊柱和膜囊，同时将相关的肌肉损伤降至最低。作者提出了开放手术和微创手术治疗成人脊髓栓系综合征的比较。6名成年患者接受了脊髓栓系的手术松解(其中2名患者还伴有脊髓纵裂)。患者年龄31~，平均47.78岁。所有的医疗记录和图像都进行了回顾。其中3例患者接受了传统的开腹椎板切除术(开腹组)，另外3例患者接受了微创(微创)脊髓剥离术。比较两组患者的手术切口长度、住院时间、估计失血量和并发症。6例患者均有脊髓栓系，每组均有1例脊髓纵裂。两组患者术中平均失血量分别为300ml和167ml(P=0.313)，平均住院时间分别为7天和6.3d(P=0.718)。小切口组的切口长度是切口组的一半。然而，小切口组中有1例术后出现假性脊膜膨出，需要手术翻修，而切开组没有翻修手术。成人症状性脊髓纵裂和脊髓栓系病例可通过微型开放入路安全有效地探查。在这个小病例系列中，作者确实发现迷你切开组的切口比切开组小50%，但他们没有发现两组之间的显著临床差异。(DOI：10.3171/2010.3.FOCUS1077)
Object. Symptomatic tethered cord and associated anomalies such as diastematomyelia rarely present during adulthood but can cause significant pain as well as motor, sensory, and bladder dysfunction. As with children, studies have shown that surgical detethering may provide improvement in pain and neurological deficits. Typical surgical management involves an open laminectomy, sectioning of the filum terminale, and exploration of the split cord malformation. Such open approaches, however, cause significant paraspinous muscle trauma and scarring. Recent advances in minimally invasive techniques allow for access to the spine and thecal sac while minimizing associated muscular trauma. The authors present a comparison of open versus minimally invasive surgery to treat adult tethered cord syndrome.Methods. Six adult patients underwent surgical release of a tethered spinal cord (2 of them also had diastematomyelia). The mean age of the patients was 47.78 years (range 31-64 years). All medical records and images were retrospectively reviewed. Three of the patients underwent traditional open laminectomies for detethering (open group) while the other 3 patients underwent minimally invasive (mini-open) spinal cord detethering. The length of the incision, length of stay, estimated blood loss, and complications were compared between the 2 groups.Results. All 6 patients had tethered spinal cords, and 1 patient in each group had diastematomyelia. The mean estimated blood loss during surgery (300 ml in the open group vs 167 ml in the mini-open group, p = 0.313) and the mean length of stay (7 days in the open group vs 6.3 days in the mini-open group, p = 0.718) were similar between the 2 groups. The incision length was half as long in the mini-open group versus the open group. However, 1 patient in the mini-open group developed a postoperative pseudomeningocele requiring surgical revision, whereas the open group had no revision surgeries.Conclusions. Cases of symptomatic diastematomyelia and tethered cord in adults can be safely and effectively explored through a mini-open approach. In this small case series, the authors did find that the mini-open group had an incision that was 50% smaller than the open group, but they did not find a significant clinical difference between the groups. (DOI: 10.3171/2010.3.FOCUS1077)