Recurrent tethered cord: outcome and follow-up of 20 de-thetering for symptomatic spina bifida: choort study.

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Child's Nervous System Pub Date : 2024-11-01 Epub Date: 2024-07-17 DOI:10.1007/s00381-024-06537-y
Vitoria Cristina de Almeida, Mila Torii Correa Leite, Patricia Alessandra Dastoli, Rodrigo Akira Watanabe, Nelci Zanon
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引用次数: 0

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.

复发性脐带拴系:20 例症状性脊柱裂去势手术的结果和随访:Choort 研究。
研究目的本研究旨在评估开放性和隐匿性脊柱裂患者术后脐带系带的发生率。确定早期诊断的警示信号以及新手术方法后的结果:方法:对圣保罗联邦大学小儿神经外科的脊柱发育不良患者进行回顾性研究。方法:对圣保罗联邦大学小儿神经外科随访的脊柱发育不良患者进行回顾性研究,收集表明需要再次手术的体征和症状,并将术后结果分为好转、不变或恶化。结果:共评估了 222 份确诊为脊柱发育不良患者的病历,其中发现 30 例患者(13.51%)患有症状性系索综合征(STCS),临床表现与骨科畸形(66.7%)、神经功能缺损(56.7%)、泌尿系统功能障碍(50%)和肠道功能障碍(40%)有关。20例患者接受了系带松解手术。手术时的平均年龄为(7.7 ± 4.9)岁,其中女性患者 13 例(65%)。在术后评估中,腰痛(90.9%)、泌尿系统模式和尿路感染发作(45.4%)的改善尤为显著。3 名便秘患者(33.3%)的情况有所改善,1 名恶化(11.1%)。有两名患者(16.7%)的行走能力有所改善。腰痛是术后最先得到改善的症状,平均改善时间为 1.3 个月,其次是泌尿系统模式的改变,平均改善时间为 15.6 个月。2例患者(66.7%)的便秘在术后第一个月就得到了改善,术后7个月左右,患者的行走能力出现了积极的变化,只有1例患者的足外翻矫正情况有所改善:结论:开放性或隐匿性神经管闭合缺损初次矫治术后系带复发率与文献报道相似。结果令人鼓舞,患者术后情况良好,尤其是腰背痛和泌尿系统症状有所改善。
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来源期刊
Child's Nervous System
Child's Nervous System 医学-临床神经学
CiteScore
3.00
自引率
7.10%
发文量
322
审稿时长
3 months
期刊介绍: The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
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