成人脊髓纵裂畸形导致的脊髓拴系综合征的治疗

Surgical treatment for adult patients with tethered cord syndrome due to split cord malformation

目的总结成年脊髓纵裂畸形(SCM)导致的脊髓拴系综合征(TCS)的临床特点及手术治疗经验。方法回顾性分析2007年9月至2019年3月手术治疗的21例成年SCM导致的TCS病人的临床资料。采用后路椎板切除、骨性或软骨性及纤维中隔分离切除、脊髓拴系松解、脊膜囊重建术。结果21例中,男6例,女15例;年龄18~65岁,平均28.7岁;Ⅰ型7例,Ⅱ型14例。21例显微手术将中隔切除,脊髓拴系达Ⅰ级松解,无手术并发症。术后疼痛缓解或消失,双下肢无力及大小便功能障碍逐渐恢复。术后随访9个月至12年,平均5.8年;神经功能稳定及好转;随访期间未见拴系复发。结论成人由SCM引发的TCS少见,以慢性腰腿痛为主要临床表现,手术在显微镜下行中隔分离切除、脊髓拴系松解及硬膜重建,疗效满意。

Objective To summarize the clinical manifestation,imaging characteristic and experience of surgical treatment of tethered cord syndrome(TCS)due to split cord malformation(SCM)in adults.Methods The clincal data of 21 adult patients with TCS due to SCM who were surgically treated under microscope from September 2007 to March 2019 were retrospectively analyzed.Results There were 6 males and 15 females with an average age of 28.7 years(range,18~65 years).Clinically,all the patients presented with chronic back and legs pain and lower extremities weakness or bowel and bladder dysfunction.Preoperative CT and MRI imaging showed spina bifida,characteristic bony,cartilaginous,or fibrous septum,and associated anomalies.According to CT and MRI features,7 patients were categorized into TypeⅠand 14 into typeⅡ.All the patients had low-lying conus medullaris and thickened filum terminale and 3 patients had meningeal cyst of filum terminal at sacral spine.21 operations had been performed including resection of the median septum,de-tethering the spinal cord,and reconstruction of the dura sac.No operative complication occurred.The local pain was relieved,and the lower limbs weakness or bowel and bladder dysfunction were gradually relieved after the operation.The period of follow-up ranged from 9 months to 12 years,with an average of 5.8 years.The neurological function was improved or stable in all the patients.Conclusions TCS due to SCM in adults is rare,which is characterized with insidious onset and chronic progressive procedure.The surgical treatment including resection of the median septum,untethering of spinal cord,reconstruction of dura sac under microscope have good outcomes.