PDF(Pubmed)
Abstract：
After myelomeningocele (MMC) repair, a secondary tethered spinal cord occurs in almost all patients. The tethered spinal cord may result in progressive neurological deterioration and walking disability. This retrospective cohort study aimed to highlight the walking recovery one year after tethered cord release and its relation to the preoperative conus level. We reviewed the medical records at our university hospital from January 2014 to December 2022. The patients who underwent spinal cord untethering following lumbosacral MMC repair were included. We assessed the walking recovery one year after cord release using the modified Benzel scale. Thirty-seven patients met our selection criteria. There were 19 girls (51.4%) and 18 boys (48.6%). Their mean age at presentation was 8.6 years. The preoperative conus vertebral levels ranged between L4 and S3. One year after spinal cord release, 37.8% of the patients regained their walking ability. All the patients whose preoperative conus level was at S2 or S3 regained their walking ability. In contrast, all the patients with preoperative conus levels at L4 or L5 didn\'t regain their ability to walk. One-third (33.3%) of patients whose conus was at the S1 level regained their walking ability one year after cord release. One year after tethered cord release, 37.8% of the patients regained their walking ability. We found that the walking recovery was statistically associated with the preoperative conus level. A multicenter prospective study is required to support the results of this study.
摘要：
脊髓膜膨出（MMC）修复后，几乎所有患者都会出现继发性脊髓栓系。束缚的脊髓可能导致进行性神经系统恶化和行走障碍。这项回顾性队列研究旨在强调栓系脐带释放后一年的步行恢复及其与术前圆锥水平的关系。我们回顾了2014年1月至2022年12月在我们大学医院的病历。包括腰骶部MMC修复后进行脊髓松脱的患者。我们使用改良的Benzel量表评估了脐带释放后一年的步行恢复情况。37名患者符合我们的选择标准。有19个女孩（51.4％）和18个男孩（48.6％）。他们的平均年龄为8.6岁。术前圆锥椎体水平介于L4和S3之间。脊髓松解术后一年,37.8%的患者恢复了行走能力。所有术前圆锥水平为S2或S3的患者均恢复了步行能力。相比之下,所有术前圆锥水平为L4或L5的患者均未恢复行走能力.圆锥处于S1水平的患者中有三分之一（33.3％）在脐带释放一年后恢复了行走能力。系绳释放一年后，37.8%的患者恢复了行走能力。我们发现步行恢复与术前圆锥水平有统计学关联。需要多中心前瞻性研究来支持本研究的结果。
