Introduction

Adults rarely present with tethered cord syndrome, and this review examines whether it is justifiable to perform surgical intervention in this group.

Methods

Between 2003 and 2017, we performed surgical intervention in 32 adults with tethered cord syndrome. The age range varied from 22 to 65 years. Twenty-six had pain, 20 had motor deficits, and 18 had sensory deficits, whereas 17 presented with sphincter disturbances. Three had undergone surgery for meningomyelocele as infants. Six patients had major spinal deformity in the shape of kyphosis or scoliosis. All patients underwent digital radiographs and MR scans of the whole spine. The oldest with a leaking open meningocele was 41 years old.

Results

The mean follow-up was 3.2 years. Twenty-one out of 26 patients presenting with pain had their VAS scores improve significantly; 14 had motor deficits which improved. However, sensory deficits got better in only 7 out of 18 patients, and sphincter improvement was documented (via urodynamics studies and bladder ultrasound) in only 4 out of 17 patients. In 15 cases, surgery was performed under neurophysiological monitoring, and overall improvement was documented in 11 of these patients compared with 7 of the remaining 17 patients. Surgery for spinal deformity was performed in 6 patients, and deformity correction as well as pain reduction was achieved in all.

Conclusion

Surgery leads to significant reduction of pain by untethering and in those with spinal deformity by correction of the same. Improvement in sensory changes and sphincter problems occurred in few patients. Neuromonitoring certainly has improved our results.

中文翻译：

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32 例成人脊髓栓系病例的结果——干预是否合理？

介绍

成人很少出现脊髓栓系综合征，本综述探讨了在该人群中进行手术干预是否合理。

方法

在 2003 年至 2017 年间，我们对 32 名患有脊髓栓系综合征的成年人进行了手术干预。年龄范围从 22 岁到 65 岁不等。26 人出现疼痛，20 人出现运动障碍，18 人出现感觉障碍，而 17 人出现括约肌障碍。三人在婴儿时期接受了脑膜脊髓膨出手术。六名患者有脊柱后凸或脊柱侧凸形式的严重脊柱畸形。所有患者都接受了整个脊柱的数字 X 光片和 MR 扫描。年龄最大的脑膜膨出者 41 岁。

结果

平均随访时间为 3.2 年。26 名出现疼痛的患者中有 21 人的 VAS 评分显着提高；14 人有运动缺陷，但有所改善。然而，18 名患者中只有 7 名感觉障碍得到改善，17 名患者中只有 4 名记录了括约肌改善（通过尿动力学研究和膀胱超声）。在 15 例中，手术是在神经生理学监测下进行的，其中 11 例患者的整体改善与其余 17 例患者中的 7 例相比有所改善。6例患者进行脊柱畸形手术，均达到矫正畸形、减轻疼痛的效果。

结论

手术通过解除束缚和矫正脊柱畸形的患者可显着减轻疼痛。少数患者出现感觉变化和括约肌问题的改善。神经监测当然改善了我们的结果。