Clinical Classification And Curative Effect Analysis Of Tethered Cord Syndrome With Lipoma

Spinal lipoma associated with dysraphism constitute an important and common cause of tethered cord syndrome and lead to progressive neurological deterioration as the child grows up. Tethering of the cord, roots or filum and the compression produced by the presence of lipoma is considered responsible for the development of the neurological and cinetic symptoms.Tethered cord syndrome(TCS), that conusmedullar is affected by changes include pathological filum, spinal cord and spilt cord malformation, fiber bundles or lipoma, dermoid cyst, etc. The adhesion of repression evokes ischemia hypoxia, lead to incontinence, the deformity of lower limbs and sensorimotor dysfunction. TCS belongs to neural tube defects, a variety of congenital dysplasia lead to one of the main pathological mechanism of nerve symptoms, generally has the obvious image characteristics, clinical symptoms and signs, such as the deformity of lower limbs, sphincter dysfunction, lumbar skin abnormalities, such as imaging findings of spinal cord, low space of filum. MRI of spinal cord that the end of the cone is below the edge of L2vertebral body can often clear diagnosis. TCS with lipoma is recognized as the most difficult kind of tethered cord syndrome to cure and prognosis of the worst kind. This type represents spina bifida and meningomyelocele,adipose tissue and spinal cord, lumbosacral nerve and filum extensive adhesion, aggressive, mixed structure growth, nerve dysfunction in progression, high morbidity, seriously affect the patients’ quality of life when they grow up. These characteristics determine the risk of operation is high, easy to damage nerves, and rethered again. Spinal Cord Disease Center of the Third Affiliated Hospital of Zhengzhou University from January2003to December2012have treated511cases of children with spinal lipoma of tethered cord syndrome, All of them get through operation to cut off lipoma, release the tethered spinal cord. In this retrospective analysis of operation treatment, postoperative recovery and complications, and discuss the reasons and treatment of postoperative complications, and provide some reference information for clinical treatment of the disease.ObjectiveAnalysis of pathological changes of tethered cord syndrome with lipoma and clinical examination findings, and then determine the types of lesions and clinical, and from the sight of clinical classification treatment to select proper operation and provide basis for prognosis judgment.Materials and methodsA retrospective analysis of511cases with tethered cord syndrome with lipoma of the Third Affiliated Hospital of Zhengzhou University from2003January to2012December were treated by tethered cord syndrome with lipoma, all patients were treated by surgical operation, all the patients underwent X-ray, CT, MRI and other necessary inspection. Compare pathological changes and clinical symptoms.The postoperation followe-up of430patients for6months～10years, evaluate the effect of treatment with spina bifida neurological scale and carry on statistics processing. Analayses the relationship between curative effect and prognosis with clinical classification. ResultsAccording to the results of the statistics of the clinical data and imaging examination is divided into six types:(1) Surface of the spinal cord type,(2)Inside of spinal cord type,(3)Filum type,(4)Wrapped type,(5)Lipomyelomeningocele type,(6)Mixed type. Results show that different types of spinal lipoma efficient treatment of tethered cord syndrome is respectively different(P<0.05), surface of the spinal cord72.9%, inside of the spinal cord63.9%, filum type86.4%, wrapped type62.5%, meningomyelocele type72.1%and mixed type58.6%. The treatment of filum type is better than inside of the spinal cord and mixed type. The total effective rate was72.3%.ConclusionsNo matter what type of tethered cord syndrome with lipoma,once diagnosed, should take early surgical treatment. Preoperative routine inspection must be executed carefully, the factors affect the lipoma type of surgery, curative effect and prognosis of tethered cord syndrome mainly include the type of lipoma, severity of the symptoms, surgical time, degree of lipoma resection and nerve release completely. Appropriate clinical classification helps to condition assessment before operation, operation method choice and prognosis.