Abstract：
OBJECTIVE: The objective of this study was to evaluate the prevalence of tethered cord among patients in the postoperative period of open and occult spina bifida. To identify warning signs for its early diagnosis, as well as outcomes after the new surgical approach.
METHODS: Retrospective study of patients followed at the Pediatric Neurosurgery Department of the Federal University of São Paulo with spinal dysraphism. Signs and symptoms indicating reoperation were collected, and postoperative results were classified as improved, unchanged, or worsened.
RESULTS: 222 medical records of patients diagnosed with spinal dysraphism were evaluated. Symptomatic Tethered Cord Syndrome (STCS) was identified in 30 patients (13.51%), with clinical manifestations related to orthopedic deformities (66.7%), neurological deficits (56.7%), urological dysfunction (50%), and intestinal dysfunction (40%). 20 cases underwent surgery for tethered cord release. The mean age at the time of surgery was 7.7 ± 4.9 years, with 13 female patients (65%). In the postoperative evaluation, improvement in low back pain (90.9%), urological pattern, and urinary tract infection episodes (45.4%) were particularly noteworthy. 3 patients (33.3%) with constipation showed improvement, and one worsened (11.1%). Improvement in ambulation was seen in two cases (16.7%). Low back pain was the first symptom to improve after surgery, with an average time of 1.3 months, followed by changes in the urological pattern at 15.6 months. Improvement in constipation was observed in the first month in 2 cases (66.7%), positive changes in ambulation were observed around 7 months after surgery, and only one case showed improvement in clubfoot correction.
CONCLUSIONS: The prevalence of tethered cord recurrence after primary correction surgery for open or occult neural tube closure defects was similar to that found in the literature. The results were encouraging, with good postoperative evolution of patients, especially in the improvement of low back pain and urological symptoms.
METHODS: Retrospective study of patients followed at the Pediatric Neurosurgery Department of the Federal University of São Paulo with spinal dysraphism. Signs and symptoms indicating reoperation were collected, and postoperative results were classified as improved, unchanged, or worsened.
RESULTS: 222 medical records of patients diagnosed with spinal dysraphism were evaluated. Symptomatic Tethered Cord Syndrome (STCS) was identified in 30 patients (13.51%), with clinical manifestations related to orthopedic deformities (66.7%), neurological deficits (56.7%), urological dysfunction (50%), and intestinal dysfunction (40%). 20 cases underwent surgery for tethered cord release. The mean age at the time of surgery was 7.7 ± 4.9 years, with 13 female patients (65%). In the postoperative evaluation, improvement in low back pain (90.9%), urological pattern, and urinary tract infection episodes (45.4%) were particularly noteworthy. 3 patients (33.3%) with constipation showed improvement, and one worsened (11.1%). Improvement in ambulation was seen in two cases (16.7%). Low back pain was the first symptom to improve after surgery, with an average time of 1.3 months, followed by changes in the urological pattern at 15.6 months. Improvement in constipation was observed in the first month in 2 cases (66.7%), positive changes in ambulation were observed around 7 months after surgery, and only one case showed improvement in clubfoot correction.
CONCLUSIONS: The prevalence of tethered cord recurrence after primary correction surgery for open or occult neural tube closure defects was similar to that found in the literature. The results were encouraging, with good postoperative evolution of patients, especially in the improvement of low back pain and urological symptoms.
摘要：
目的：本研究的目的是评估开放性和隐匿性脊柱裂术后患者脊髓栓系的患病率。为了识别早期诊断的警告信号，以及新手术方法后的结果。
方法：对圣保罗联邦大学儿科神经外科脊柱发育不良患者的回顾性研究。收集再次手术的体征和症状，术后结果被归类为改善，不变,或恶化。
结果：对222例诊断为脊柱发育不良的患者的医疗记录进行了评估。有症状的脊髓栓系综合征（STCS）在30例（13.51％）中被发现，临床表现与骨科畸形有关（66.7%），神经功能缺损（56.7%），泌尿系统功能障碍（50%），肠功能障碍（40%）。20例患者行脊髓栓系松解术。手术时的平均年龄为7.7±4.9岁,13名女性患者（65%）。在术后评估中，下腰痛改善（90.9%），泌尿外科模式,尤其值得注意的是尿路感染(45.4%)。3例（33.3%）便秘患者改善，和一个恶化(11.1%)。2例（16.7％）的步行改善。下腰痛是手术后改善的首发症状，平均时间为1.3个月，其次是在15.6个月时泌尿外科模式的变化。2例（66.7％）在第一个月观察到便秘的改善，术后7个月左右观察到步行的积极变化，只有一例显示马蹄内翻足的改善。
结论：针对开放性或隐匿性神经管闭合缺陷的初次矫正手术后脊髓栓系复发的发生率与文献中发现的相似。结果令人鼓舞，患者术后进展良好，尤其是在改善腰痛和泌尿系统症状方面。
方法：对圣保罗联邦大学儿科神经外科脊柱发育不良患者的回顾性研究。收集再次手术的体征和症状，术后结果被归类为改善，不变,或恶化。
结果：对222例诊断为脊柱发育不良的患者的医疗记录进行了评估。有症状的脊髓栓系综合征（STCS）在30例（13.51％）中被发现，临床表现与骨科畸形有关（66.7%），神经功能缺损（56.7%），泌尿系统功能障碍（50%），肠功能障碍（40%）。20例患者行脊髓栓系松解术。手术时的平均年龄为7.7±4.9岁,13名女性患者（65%）。在术后评估中，下腰痛改善（90.9%），泌尿外科模式,尤其值得注意的是尿路感染(45.4%)。3例（33.3%）便秘患者改善，和一个恶化(11.1%)。2例（16.7％）的步行改善。下腰痛是手术后改善的首发症状，平均时间为1.3个月，其次是在15.6个月时泌尿外科模式的变化。2例（66.7％）在第一个月观察到便秘的改善，术后7个月左右观察到步行的积极变化，只有一例显示马蹄内翻足的改善。
结论：针对开放性或隐匿性神经管闭合缺陷的初次矫正手术后脊髓栓系复发的发生率与文献中发现的相似。结果令人鼓舞，患者术后进展良好，尤其是在改善腰痛和泌尿系统症状方面。
