Anatomic Study On The Vertebral Level Of The Termination Of The Spinal Cord And Distribution Of Neural Stem Cells In The Filum Terminale

ObjectiveTethered cord syndrome (TCS) is the common disease in pediatric surgery. In present, the European diagnosis standard is adopted in China, that is, the vertebral level of termination of the spinal cord bellowing the third lumbar vertebra and its following symptoms. One of the major strategies for tethered cord syndrome is surgical untethering, but the effect for some patients is not any satisfaction. The recent studies indicate that there is difference between the level of conus medullaris in Europe and that in Asia, and the progression of basic research of neural stem cells provides the great promise for the future of TCS. This thesis is to study the Vertebral level of the termination of the spinal cord in order to provide early diagnostic basis for tethered cord or tethered cord syndrome in Chinese fetuses and neonates and instruct the operation of the lumbar puncture and anesthesia. It is also to study the distribution of neural stem cells in the filum terminale of children in order to provide the newer measures against tethered cord syndrome or other diseases of center neural stem.Materials and Methods1. Anatomic study was performed in 124 fetuses and full-term neonates who had died within a few hours after the birth. By freeing the 12th rib and transverse process of vertebral centrums was regarded as the marker, the crown—rump length (CRL) of thespecimens were measured and divided into 8 smaller groups (â…  to â…§) by Vettivel. The level taken as the termination of the spinal cord is the level of attachment of the lowest spinal nerves. The lower end of the conus medullaris is located the margo superior of the transverse process base. It means that the margo superior of the Vertebral body. The inferior margo means that the midpoint. The mid-position of two transverse processes means the margo inferior, between the superior margo and the inferior margo. It is also called the disc. The results were statistically analyzed .2. Forty specimens of the distal and proximal intradural filum terminale from the people suffering from the tethered cord syndrome were selected for the observation on the expression of nestin by the means of immunohistochemistry .Results1.The spinal cord terminate at the level of the 2nd lumbar vertebra (L₂) in the newborn, 78.26% in â…§, above the L₂ is 33.33% in â…¦ (5 cases). Chi-square test indicates that the level of conus medullaris is not significantly different between female and male specimens ( x ²=17.764, P=0.338>0.005). The conus medullaris levelascends gradually with the difference of crown-rump length of fetuses—the development of fetuses.2. Nestin positive cells were found in the distal and proximal filum terminale. Fifteen out of twenty-two specimens of the proximal intradural filum terminale showed the positive expression of nestin. The positive rates of nestin were 68.1%. Ten out of eighteen specimens of the distal filum terminale showed the positive expression of nestin. The positive rates were 55.6%. There is no significant difference between the nestin expressions of distal and proximal intradural filum terminale.there is neural stem cells in the filum terminaleConclusions1.The position of the lower end of the conus medullaris reaches the adult level in term neonates even in fetuses, which is higher than that of other reports in China, which provides the reference for early diagnosing tethered cord and tethered cord syndrome infetuses and neonates and instructing the operation of the lumbar puncture and anesthesia2.There were nestin positive cells in the filum terminale of tethered cord syndrome, which will offer the theoretical basis about the neural stem cells treatment therapy for tethered cord syndrome and inducement and differentiation of neural stem cells from the filum terminale of patient...