| ObjectiveStudy the surgical pathology of neural-tube defects and the relationship of different lesions on spinal cord with the outcome in order to improve the diagnosis and treatment of the disease.Materials and Methods107 patients presented with neural-tube defects were assessed prospectively, including the diseases histories, physical examines, X-ray on spines, magnetic resonance imaging (MRI), voiding cystourethrogra-phy(VCUG) and Ultrasonography of urinary system. Parts of the patients were assessed with urodynamics, electromyography (EMG), rectoanal dynamics and CT. The patients diagnosed with myelodysplasia of intraspinal anomalies underwent surgical correction of the anomalies, the patients with meningocele only were underwent surgical meningocele repair. The intraspinal anomalies and their relation with spinal cord were observed in the operations. We quantized the information of clinic before the surgery and the corresponding information following-up after the operation. Finally, analysis of variance (ANOV) was utilized to compare the outcome of patients with different intraspinal lesions.Results1. Common materials:all 107 patients,62 males,45 females (male/ female= 1.38/1), operation ages ranged from 4 days to 37 years (mean age 7.41 years). The follow-up time ranged from 3 months to 11 years (mean time 2.5 years).55 among the 107 patients presented with history of meningocele repair.2. Pathoanatomy:(1) Intraspinal anomalies:According to the MRI and the informations observing in the operation, such as morphological changes of spinal cord, the intraspinal lesions and its relationship with spinal cord, we divided the 107 patients into 6 types of lesions, including tight terminal filum type (â… ) 20 patients, fibrous adhesion of the spinal cord(â…¡) 27 patients, lipoma and lipomyelomeningocele type (â…¢) 30 patients, intraspinal cyst type(â…£) 15 patients, diastematomyelia(â…¤) 10 patients and the type with passage of spinal cord or nerve roots absence (â…¥) 5 patients.3. Clinic presentation:Lower-extremity pain all improved in 25 patients. Lower-extremity weakness and foot malformation reccured in 3 patients, improved in 21 patients, remained unchanged in 35 patients and worsened in 2 patients. Urine incontinence or dysuria reccured in 5 patients, improved in 24 patients, remained unchanged in 53 patients and worsened in 10 patients.3 patients with constant ulcer of lower limb resumed after operation. Quantized the clinical charts of patients, the decreasing of score indicated the condition improved, the increasing of score indicated the condition worsened. All 107 patients improved in 29 patients, remained unchanged in 64 patients, worsened or worsened after improvement in 14 patients.4. Integrative evaluation and statistic analysis:The result of ANOV (F Test) among the outcome of 6 groups (Typeâ… , Typeâ…¡, Typeâ…¢, Typeâ…£, Typeâ…¤and TypeVI) was significant different (P<0.05). The results of t-test for independent samples between different groups indicated 6 pairs with significant difference(P<0.05). Conclusions1. The process of tethered cord syndrome is progressively deteriorated on neurology, their pathogenesis of the neurological lesions on spinal cord consist of 4 mechanisms, including the stretch to coni medullaris, compression to the spinal cord, the adhesion of nerve roots and static mechanism. Their pathogenesis is the intraspinal anomalies.2. Neural tube defects can be divided into 6 types. There are significant differences in their morphological changes, their major mechanism of the neurological lesions on spinal cord, their clinic presentations and outcome among the 6 types.3. Neural tube defects should be diagnosed and surgically treated as soon as possible in order to prevent the further progressing deterioration, the therapy of urine incontinence also be taken and complete removing of the intraspinal lesion should be taken. The examination (such as MRI, Urodynamics, EMG) must be taken to make sure whether the patients with intraspinal anomalies before meningocele repairs.4. Propagation and education on the use of folic acid is an effective way to decrease the morbidity. |
