Efficacy Of Microscopic Channel Sectioning A Filum Terminates For Tethered Cord Syndrome

BackgroundTethered Cord Syndrome（TCS）is a clinical syndrome caused by abnormal fixation of terminal filament in the spinal cord.Some patients have syringomyelia,the incidence is22.5% to 53%,but the specific pathogenesis is not clear.Currently,surgery is the main treatment for TCS,and terminalysis is still the mainstream operation.The operation can relieve the abnormal fixed spinal cord and improve the ischemia and hypoxia of spinal cord tissue,so as to achieve the purpose of TCS treatment.However,the therapeutic effect of terminalysis in treating TCS caused by terminal filament disease alone and TCS with syringomyelia is not completely clear,and further study is needed.ObjectivesThis study retrospectively analyzed the clinical effects of microscopically channelized spinal cord terminalysis in the treatment of TCS caused by terminal filament lesions and TCS with syringomyelia under neuroelectrophysiological monitoring,and provided clinical data support for the diagnosis and treatment of TCS.At the same time,the pathogenesis of TCS combined with syringomyelia was preliminatively discussed by comparing the changes of cerebrospinal fluid dynamics before and after TCS surgery.MethodsA total of 81 patients with TCS caused by terminal filament lesions were selected in the Department of Neurospinal Surgery,Zhengzhou Central Hospital affiliated to Zhengzhou University from October 2019 to October 2021,including 35 patients with syringomyelia and 46 patients without syringomyelia.All patients were treated with microscopic channel sectioning a filum terminates surgery.To investigate the clinical efficacy of sectioning a filum terminates in the treatment of TCS caused by terminal filament lesions,the clinical data of 81 patients were collected and analyzed retrospectively.Patients with TCS combined with syringomyelia were group A（n=35）and patients with TCS alone were group B（n=46）.By analyzing the improvement of clinical symptoms,the changes of the peak flow of ventral and dorsal conus spinalis,and the changes of the maximal cross-sectional area of syringomyelia in group A before and after the microscopical channel operation,the clinical efficacy of microscopical channel sectioning a filum terminates in the treatment of TCS caused by terminal filament lesions alone and with syringomyelia was discussed.At the same time,the correlation between preoperative neuroelectrophysiological detection results and clinical symptoms was analyzed to provide clinical data support for the early diagnosis of TCS patients.Results1.There was no significant demographic difference between group A and group B before surgery.Clinical symptoms were classified into Hoffman functional grades,the clinical symptoms of group A were more severe than that of group B（H=3.905 P<0.05）.Preoperative PC-MRI measurements showed a significant decrease in peak flow in both ventral and dorsal conus in group A（P<0.001）,and a longer time for Queckenstedt to reach a plateau（P<0.001）.The neuroelectrophysiological monitoring results of all patients were analyzed,and the correlation analysis results with clinical symptoms showed that the neuroelectrophysiological testing results of patients were correlated with the functional grade of Hoffman（R =0.696 P<0.01）.2.Compared with group B before and after surgery,the maximum cross-sectional area of syringomyelia in group A was significantly improved（P<0.01）;PC-MRI results showed that the peak flow in ventral and dorsal conus of patients in group A was increased compared with pre-operation（P<0.001）,and the time to the plateau of the Queckenstedt test was significantly shortened compared with pre-operation（P<0.001）.In group B,there were no significant differences in the peak flow of ventral and dorsal conus before and after surgery and the time to plateau of Queckenstedt test（P>0.05）,77.78% of patients（63/81 cases）had significant improvement in clinical symptoms after surgery.Conclusions1.Patients with TCS complicated with syringomyelia due to pure filar terminus disease have cerebrospinal fluid dynamics disorders and have more serious clinical symptoms and signs.2.Neuroelectrophysiological testing can assist in the early diagnosis of TCS,especially for OTCS patients who lack obvious imaging manifestations.3.Sectioning a filum terminates can achieve certain efficacy in the treatment of patients with TCS caused by terminal filament lesions and patients with TCS combined with syringomyelia.In patients with TCS combined with syringomyelia,the reduction of syringomyelia and improvement of clinical symptoms can be achieved through microscopic channel pathway.