| [Background]Tethered cord syndrome(TCS)is a common disease in pediatric neurosurgery.It usually develops progressively with silent onset in infants and children,which can lead to continued progression of neurological dysfunction and high disability rates without intervention in a timely manner.As early as 1950,scholars had proposed the progressive deterioration of neurological function in patients with TCS,and emphasized the value of early prophylactic surgery.However,there is still debate about how these lesions should be managed.At first,people think surgery just for the purpose of improving the appearance,with the development of a deeper understanding of diseases and surgical technique,some scholars began to recognize the preventive importance to hidden developmental disorders of the spine surgery,but for the lipoma type spinal cord tied to maintain a conservative attitude,because the common cognitive is lipoma type spinal cord tied to anatomical structure is more complicated,it is difficult to assess the value of the operation.Many surgeons argue that unless there is clear evidence of neurological deterioration,there is no need for surgery in these cases.With the introduction of modern management concept of TSC with lipoma in the late 20 th century,some neurosurgeons began to propose the mechanism of nervous system deterioration in patients with tethered spinal cord with lipoma,and suggested early and aggressive treatment measures.Lipomatous tethered cord is a type of tethered cord.Most of the children were accompanied by sacrococcygeal mass and other skin manifestations.A child may be born without any neurological symptoms,but over time,the symptoms may develop and become difficult to heal,eventually worsening.Whether prophylactic surgery should be performed to remove the tether and remove the lipoma in symptomatic lipomatous spinal cord tether has always been controversial.[purpose]To evaluate the risks and significance of prophylactic surgery in tethered spinal cord therapy for asymptomatic lipoma in children.[Methods]A total of 303 literatures related to tether therapy of asymptomatic lipoma of the spinal cord in children were retrieved from Pub Med and Embase databases.After preliminary reading of article titles and abstracts,a total of 256 literatures were excluded according to the above criteria.In the remaining 47 literatures,case reports,clinical reviews and literature reviews were further excluded.Among the remaining22 articles,7 non-randomized controlled clinical trials included clinical data on prophylactic surgery and conservative treatment.[Results]A total of 452 patients were enrolled in the seven studies,with a maximum follow-up of 20 years.A total of 140 patients in the conservative treatment group were included,among whom 44 patients had deteriorated neurological function during the follow-up.A total of 312 children received surgical treatment,and 35 cases developed postoperative neurological dysfunction,the difference was statistically significant.At the same time,a total of 13 literatures on surgical treatment alone were retrieved,with a total of 385 patients.These 13 literatures were combined,and 42 patients developed postoperative neurological deterioration.And 2 articles on conservative treatment alone,and the clinical data were also combined.A random-effect model was established to compare the deterioration rate between surgical treatment alone and conservative treatment alone,and the difference was statistically significant.[Conclusion]For spinal cord lipomas in children,limited literature currently supports the benefit of prophylactic surgery in children.However,different treatment strategies may be required for different lipoma subtypes,and there is a lack of longer follow-up and larger evidence-based medical studies. |
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