Surgical Treatment And Prognosis Analysis Of Children Tethered Cord Syndrome

Background and Objective: Tethered cord syndrome(TCS) is a clinical condition of various origins that arises from tension on the spinal cord. Radiographic findings may include the conus medullaris in a lower than normal position, fatty infiltration of the filum terminale, lipomyelomeningocele, myelomeningocele, myelocystocele, meningocele, split cord malformations, dermal sinus, anorectal malformations, and intraspinal tumors. Tethered cord syndrome is mainly found in children, females are more than male. Currently the prefered treatment of tethered spinal cord is surgery, through untethering the end of spinal cord, restoring the blood circulation of spinal cord ends, so as to relieve various symptoms of neurological function. The complex pathological types, variety of neurological symptoms and duration, patient age, lead to varied prognosis of the patients. In order to analyze the prognosis of tethered cord syndrome in children patients with surgical treatment and the effect of age, gender, preoperative symptoms, image manifestation, intraoperative assistive technology on the outcome of patients with surgery, we respectively analyzed 45 cases who received surgical treatment for tethered cord syndrome.Materials and Methdos: Through collection of preoperative and postoperative symptoms, MRI findings, surgical conditions of TCS patients, to evaluate the surgical effect and related factors affecting the prognosis. 45 patients of TCS who underwent surgical treatment between 2012 and 2015 at the Department of Neurosurgery, Tongji Hospital Affiliated to Huazhong University of science and Technology were retrospectively analyzed. Lumbosacral MRI were performed in all patients before surgery, 1 week postoperative and during periodic reviews. Patients age, gender, MRI, preoperative and postoperative sohinctoer functions, strength andmalformations of the lower limbs, intraoperative neural electrophysiological monitoring and CUSA usage were included as the major statistical indicators, the patients were followed up for 3-50 months. The use of Intraoperative neural electrophysiological monitoring and CUSA, age at surgery, preoperative symptoms and MRI performance as independent risk factors were analyzed. P < 0.05 was statistically significant.Results: All 45 patients with tethered cord syndrome patients underwent surgery treatment, Before surgery,18 cases(40%) was asymptomatic, 16 cases(35.56%) had urine and bowel dysfunctions, 17 cases(37.78%) had lower limb movement disorder, 6 cases had both lower limbs and urine and bowel dysfunctions. Most patients had a good results after 3-50 months of follow-up, aggrevated after operation in 5 cases(11.11%), unchanged in 21 cases(46.67%), improved in 19 cases(42.22%). The 26 cases of lumbosacal lipomas were asymptomatic in 12 cases(46.15%), symptomatic in 14 cases(53.85%)(3 cases of lower limbs activity obstacle, equinovarus deformity in 3 cases, inequality of lower limbs in 2 cases, urine and bowel dysfunction in 5 cases, 1 case had both lower limbs and urine and bowel dysfunctions), unchanged postoperative in 18 cases(69.23%), improved in 5 cases(19.23%), aggravated in 3 cases(11.54%).Conclusions: Surgical treatment can significantly improve the neural dysfunction of tethered cord syndrome and prevent new neurological dysfunction in children tethered cord syndrome patients. The use of intraoperative neural electrophysiological monitoring and CUSA can significantly reduce the occurrence of surgical complications.The prognosis of TCS was better in younger and asymptomatic patients. In spinal cord lipomas, the prognosis of the chaotic type was worse than dorsal and transitional types.