背景:脊髓栓系综合征(TCS)继发于脊髓分裂畸形(SCM)在成年期很少见。目前还没有共识的最佳治疗方法为成年患者的SCM和退行性脊柱疾病,如腰椎管狭窄,脊椎滑脱和黄韧带骨化(OLF)。栓系脊髓对术中拉伸脊髓的减压和融合程序提出了很大的挑战,这可能会导致神经缺陷恶化。这里,我们报告了一个病例,以将我们的治疗经验添加到医学文献中。
方法:我们治疗了一名患有腰椎间盘突出症的67岁女性II型SCM患者,退行性腰椎滑脱和胸椎OLF。该患者因严重的下背部疼痛而接受了胸腰椎融合术和减压手术,广泛的左下肢肌肉无力和间歇性跛行。胸腰椎手术后,不拉伸系绳,在最后的随访中,患者的疼痛和下肢无力完全缓解.
结论:对于患有SCM继发TCS并伴有胸椎OLF和腰椎滑脱的成年患者,未经栓系的脊髓治疗,胸腰椎融合术可能是安全有效的。设计个性化的手术方案以减少低洼脊髓的拉伸至关重要。
BACKGROUND: Tethered cord syndrome (TCS) secondary to split cord malformation (SCM) is rare in adulthood. There is as yet no consensus about the optimal treatment method for adult patients with SCMs and degenerative spine diseases such as lumbar stenosis, spondylolisthesis and ossification of the ligamentum flavum (OLF). The tethered cord poses a great challenge to the decompression and fusion procedures for the intraoperative stretching of the spinal cord, which might lead to deteriorated neural deficits. Here, we report on a case to add our treatment experience to the medical literature.
METHODS: We treated a 67-year-old female patient with type II SCM suffering from lumbar disc herniation, degenerative lumbar spondylolisthesis and thoracic OLF. The patient underwent thoracolumbar spinal fusion and decompression surgery for severe lower back pain, extensive left lower limb muscle weakness and intermittent claudication. After the thoracolumbar surgery, without stretching the tethered cord, the patient achieved complete relief of pain and lower extremity weakness at final follow-up.
CONCLUSIONS: For adult patients with underlying TCS secondary to SCM coupled with thoracic OLF and lumbar spondylolisthesis, a thoracolumbar fusion surgery could be safe and effective with the tethered cord untreated. It is critical to design individualized surgical protocols to reduce the stretch of the low-lying spinal cord.