目的:脊髓栓系综合征(TCS)可导致严重的下游神经功能缺损,包括步态恶化,失禁,和经常无法解释的慢性腰痛。手术干预可以缓解症状,但没有明确的与手术结果和功能状态相关的放射学参数.作者旨在定义评估TCS手术结果的术前和术后放射学参数。
方法:作者对2016年至2021年接受TCS治疗的所有儿科患者进行了单中心回顾性研究。患者基线特征和手术指标包括年龄,性别,圆锥的水平,程序级别,束缚病理学,出现时的症状,并发症,改善症状,和再手术率。MRI测量包括术前和术后前管距离(ACD)和弯曲角度(BA)。
结果:确定了33例儿科患者,他们在2016年至2021年之间进行了脊髓松脱,并进行了术前和术后MRI检查。患者平均年龄为5.64±5.33岁。20例(60.60%)为女性。关于松绑的地点,在腰骶部区域进行了31次手术(93.93%),在胸腰椎区域进行了2次手术(6.06%)。21.21%的患者发现延髓圆锥高于L3。术后,18.18%的患者出现并发症,48.48%的人症状有所改善,48.48%的患者模棱两可或有持续性症状。术前平均ACD0(从椎体后缘[中]到延髓前缘测量)为6.15±3.18mm,术后ACD0为2.25±2.72mm,ACD0的平均变化为-0.90±1.31mm。术前平均BA为26.00°±11.56°,术后平均BA为15.92°±9.81°,BA的平均变化为-10.08°±8.80°。术前BA预测接受手术的复杂TCS患儿再次手术的最佳临界值为≥31.70°(曲线下面积=0.83)。
结论:在手术治疗的TCS患者中,某些术前放射学参数对于预测术后手术结局可能很重要;可以对这些参数进行评估和报告,以提示并发症高危患者.有必要进行进一步的前瞻性多中心研究,以提供可靠的证据证明TCS患者预后与术前放射学参数之间的关联。
Tethered cord syndrome (TCS) can lead to significant downstream neurological deficits including gait deterioration, incontinence, and often unexplained chronic low-back pain. Surgical intervention may relieve symptoms, but there are no defined radiological parameters associated with surgical outcomes and functional status. The authors aimed to define pre- and postoperative radiological parameters for assessing surgical outcomes in TCS.
The authors performed a single-center retrospective review of all pediatric patients treated for TCS between 2016 and 2021. Patient baseline characteristics and operative metrics included age, sex, level of conus, level of procedure, tethering pathology, symptoms at presentation, complications, improvement of symptoms, and reoperation rate. MRI measurements included pre- and postoperative anterior canal distance (ACD) and bending angle (BA).
Thirty-three pediatric patients were identified who underwent
untethering of the spinal cord and had pre- and postoperative MRI between 2016 and 2021. The mean patient age was 5.64 ± 5.33 years. Twenty patients (60.60%) were female. Regarding the site of
untethering, 31 procedures (93.93%) were performed at the lumbosacral region and 2 (6.06%) were performed at the thoracolumbar region. The conus medullaris was found above L3 in 21.21% of patients. Postoperatively, 18.18% of patients experienced complications, 48.48% showed improvement in their symptoms, and 48.48% were equivocal or had persistent symptoms. The mean preoperative ACD0 (measured from the posterior vertebral body margin [middle] to the anterior margin of the conus medullaris) was 6.15 ± 3.18 mm, the postoperative ACD0 was 2.25 ± 2.72 mm, and the average change in ACD0 was -0.90 ± 1.31 mm. The mean preoperative BA was 26.00° ± 11.56°, the mean postoperative BA was 15.92° ± 9.81°, and the average change in BA was -10.08° ± 8.80°. An optimal cutoff value for preoperative BA to predict reoperation in pediatric patients with complex TCS undergoing surgery was ≥ 31.70° (area under the curve = 0.83).
In surgically treated patients with TCS, certain preoperative radiological parameters may be important in predicting postoperative surgical outcomes; these parameters can be evaluated and reported to indicate patients at high risk for complications. Further prospective multicenter research is warranted to offer robust evidence of association of patient outcomes with preoperative radiological parameters in TCS.