Tethered cord release: a long-term study in 114 patients Clinical article
Tethered cord release: a long-term study in 114 patients Clinical article
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DOI：
10.3171/2008.12.peds0874
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发表时间：
2009-03-01
影响因子：
1.9
通讯作者：
McLone, David G.
中科院分区：
文献类型：
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作者：
Bowman, Robin M.;Mohan, Avinash;McLone, David G.
Object.在作者所在机构出生的所有患有脊髓脊膜膨出的儿童都接受了积极的治疗，以维持或改善功能结果。因此，当注意到任何神经、骨科和/或泌尿系统变化时，开始查找原因。脊髓脊膜膨出患儿最常见的下降原因是分流功能障碍。第二个最常见的原因是在原始背部闭合部位的远端脊髓栓系。在这份报告中，作者回顾了症状性脊髓栓系的指标，并讨论了1975年至2008年在儿童纪念医院接受治疗的脊髓脊膜膨出儿童的手术干预和结果。在儿童纪念医院接受最初闭合的502名儿童中，114名（23%）出现症状性脊髓栓系。81例患者（71%）接受了1次解栓手术，33例患者（29%）接受了多次解栓手术，共计163次手术。症状性脊髓栓系的指标包括脊柱侧凸、下肢（LE）运动强度下降、LE挛缩、LE痉挛、步态改变、排尿改变和疼痛。疼痛显示出对手术解栓的最佳反应，100%的儿童经历了术后改善。该队列的长期随访结果（平均12年，范围1个月-23.3年）表明，52%的患者在手术松解后脊柱侧凸进展，28%的患者需要脊柱融合。在术后3个月的手动肌肉测试中，与术前相比，70%的患者显示LE肌力改善。步态也得到了类似的改善后，untethering由骨科医生评估。在三分之二的队列中，痉挛得到改善，正如预期的那样，根据骨科和康复医学专家的评估，术后LE挛缩稳定（78%）。泌尿外科方面，64%的患者术后膀胱评估显示改善。虽然这是一项没有对照组的临床结局研究，但作者的经验是，脊髓栓系松解有利于维持出生时患有脊髓脊膜膨出的儿童的神经、泌尿和骨科功能。(DOI：10.3171/2008.12.PEDS0874）
Object. All children born with a myelomeningocele at the authors' institution undergo aggressive treatment to maintain or improve functional outcome. Consequently, when any neurological, orthopedic, and/or urological changes are noted, a search for the cause is initiated. The most common cause of decline in a child born with a myelomeningocele is shunt malfunction. The second most common cause is tethering of the distal spinal cord at the site of the original back closure. In this report, the authors review the indicators of symptomatic spinal cord tethering and discuss the surgical interventions and outcomes in the children with myelomeningocele who underwent treatment at Children's Memorial Hospital from 1975 to 2008.Methods. Among the 502 children who underwent original closure at Children's Memorial Hospital, a symptomatic tethered spinal cord developed in 114 (23%). Eighty-one patients (71 %) have undergone 1 untethering procedure, and 33 patients (29%) have undergone multiple untetherings, for a total of 163 total surgeries. The indicators of symptomatic spinal cord tethering include scoliosis, decline in lower-extremity (LE) motor strength, LE contractures, LE spasticity, gait change, urinary changes, and pain.Results. Pain has shown the best response to surgical untethering, with 100% of children experiencing postoperative improvement. The results of long-term follow-up (average 12 years, range 1 month-23.3 years) in this cohort demonstrated scoliosis progression after surgical untethering in 52% of patients, with 28% requiring spinal fusion. On the 3-month postoperative manual muscle test, 70% of patients showed improved LE muscle strength compared to preoperatively. Gait was also similarly improved after untethering as evaluated by an orthopedic surgeon. Spasticity improved in two-thirds of the cohort, and as expected, LE contractures were stable (78%) postoperatively, as assessed by orthopedic and rehabilitation medicine specialists. Urologically, 64% of patients showed improvements on postoperative bladder evaluation.Conclusions. Although this is a clinical outcome study with no control group, the authors' experience has been that tethered cord release is beneficial in maintaining neurological, Urological, and orthopedic functioning in children born with a myelomeningocele. (DOI: 10.3171/2008.12.PEDS0874)