| Objective:To study the pathogenetic mechanism of tethered cord syndrome, the relationship between the clinical manifestation and the clinical classification, make the classify criteria, terminal cistern expanding and remolding operation in evaluating the therapeutic effects and the prognoses was studied.Materials and methods:Sixty seven cases in neurosurgery of Jinan Military General Hospital that diagnosised as treated tethered cord syndrome from July 2004 to August 2006 were reviewed.The preoperative evaluation was based on clinical symptoms,the structures and the nervous function which were involved,and combined with international classification standard of spinal cord injury neurography (Amendment in 2000) and assisted examinations such as neuroelectrophysiological examination,ultrasonography,urodynamic study,residual urine and so on. To analyze the correlation between the abnormality degrees of above indexs and clinical manifestation,look for some indexs which could accuratly reflect the degree of the lesion.Judge the types of the degree and classified them according to those indexs. All patients underwent surgical treatment were investigated before operation,ten days after operation and half a year after operation, and defined them as before operation group,ten days group and half a year group respectively according to the difference of those indexs.The patients of the three groups were treated with same examination method ten days and half a year after operation respectively, and to know the situation of the indexs postoperative. Use statistics method to analyse the results and judge the short-term and long-term therapeutic effect of patients with tethered cord syndrome.Results:There were abnormal clinical symptoms,neuro electro-physiological examination,ultrasonography,urodynamic study,residual urine examination of patients with treated tethered cord syndrome, especially neuro electro-physiological examination could earlier reflect patients'nerve injury extent before the clinical symptom appeared,such as deformity of the lower limbs,myasthenia and paralysis.Urodynamic study and residual urine examination could reflect bladder sphincter function before aconuresis symptom appeared, the abnormal degree is responsible to the urinary incontinence which was aggravated.The degree of clinical manifestation of patients was associated with the abnormal degree of the index obviously by statistical analysis.Magnetic resonance imaging (MRI) showed that the position of circular cone and course have no obvious significant for disclosuring the degree of the disease. It shows that nerve injuries results in clinical symptom appeared, Because of different patient has different pathological structure,so the processions,the development of disease situation and the severity of the diseaseare also, different. Therefor, those indexs could servesd as clinical routine examination means, Based on the abnormal degree of the indexs, the patients with Tethered Spinal Cord Syndrome were divided into 4 types:asymptomatic,mild nerve involved,moderate nerve involved and severe nerve involved. The re-examination results of ten days after operation and six months after operation showed that terminal cistern expanding and remolding operation reached good therapeutic effect to asymptomatic,6 months after operation. Ten days after operation,no aggravated patients occurred in these cases,the cure rate of mild nerve involved was 18.57%, the improving rate was 75%; six months after operation the cure rate was 50%, the improving rate was 50%; all indexs were improved greatly after operation.The clinical symptoms of moderate nerve involved patients were relieved significantly,ten days after operation,the cure rate of moderate nerve involved was 0.00%, the improving rate was 32.43%; six months after operation the cure rate was 21.62%, the improving rate was 48.65%; all indexs were improved greatly after operation, no aggravated patients occurred in these cases.The surgical effect of severe nerve involved were comparatively worse, ten days after operation,the cure rate of severe nerve involved was 0.00%, the improving rate was 28.57%; six months after operation the cure rate was 14.28%, the improving rate was 57.15%.Thus it drew the conclusion that the surgical effect of patients with TCS depend on the degree of nerve involved, the severer the degree of nerve involved, the worse the surgical effect is. It has also been detected that the therapeutic of terminal cistern expanding and remolding operation was effective for patients with TCS, the clinical symptoms were universal improved after operation and the long-term effect was better than the short-term effect. But the short-term surgical effect of patients with severe nerve involved was not obvious, the long-term surgical effect were effective improved. And it is effective in preventing Clinical Symptoms becomes further aggravated.Conclusion:This clinical classification method is compatible with the pathologic developing process of myeleterosis and can reflect the grades of the lesion.It is very important for clinics in the diagnosis, treatment and anticipating the prognosis.It is believe that this operation design is rational which meets the demands of anatomy and physiology and its therapeutic effects is reliable which could effectively allievate clinical symptoms in patients.It is a Reasonable method which is worthily recommended in the clinical application.
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