DOI: 10.25881/20728255_2022_17_2_32

Authors

Abdullaev D.E., Yugay I.A., Ahmediyev M.M., Ergashev O.F.

Republican specialized scientific and practical medical center of neurosurgery, Tashkent, Uzbekistan

Abstract

The results of surgical treatment of children who underwent surgery for fixed spinal cord syndrome were analyzed. The features of the surgical technique for eliminating fixation of the spinal cord in closed dysraphism were determined, which made it possible to improve the results of treatment. In total, from 2019 to 2022, 61 children were operated on for a fixed spinal cord. Of these, in 52 (85.2%) patients, fixation of the terminal filament was combined with lipomeningocele, diastematomyelia, or myelomeningocele. All patients underwent a detailed study with magnetic resonance imaging (MRI) and computed tomography MSCT, performed electroneuromyography (ENMG), as well as tractography. In all these patients, the release of the stretched spinal cord and roots, as well as the dissection of the arachnoid and fibrous cords, was performed surgically using intraoperative monitoring and microscopic techniques. The results of the study were compared with a retrospective control group of patients, consisting of 55 patients. At the same time, it was found that the approach used by us significantly improved the condition in the long-term period according to electroneuromyography and neurological deficit in 29.5% of patients with pelvic disorders and in 19.6% of patients with motor disorders of the main group.

Keywords: spinal dysraphysm, thetered syndrom, neuromonitoring.

References

1. Sisoev KV. Skritiy sindrom fiksirovannogo spinnogo mozga u detey. Neyrohirurgiya. 2016; 3: 53-58. (In Russ). doi: 10.17650/1683-3295-2016-0-2.

2. Sisoev KV. Rezultati hirurgicheskogo lecheniya detey s sindromom fiksirovannogo spinnogo mozga. Prognoz na osnovanii dannih spinalnoy 3Tl MR-tractografii. Voprosi neyrohirurgii im.N.N.Burdenko. 2016; 3: 66-73. (In Russ). doi: 10.17116/neiro 201680366-73.

3. Vloo P. De. A Cadaver Study of Anatomy, Histology, and Elastic Properties. World Neurosurg. 2016; 90: 565-573. doi: 10.5603/fm.a2018.0041.

4. Husain A.M. Prognostic value of neurophysiologic intraoperative monitoring in tethered cord syndrome surgery. J Clin Neurophysiol. 2009; 26(4): 244-247. doi: 10.1097/WNP.0b013e3181b2edae.

5. Browd S, Zauberman J, Karandikar M, Ojemann J, Avellino A, et al. A new fiber-mediated carbon dioxide laser facilitates pediatric spinal cord detethering. Journal of Neurosurgery: Pediatrics. 2009; 22(3): 280-284. doi: 10.3109/03091909809010011.

6. Yamada S. Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg. 2007; 23(2): E6. doi: 10.3171/foc-07/08/e6.

7. Sanchez T. Early identification of tethered cord syndrome: a clinical challenge. J Pedietr Health Care. 2014; 28(3): 23-33. doi: 0.1016/j.pedhc. 2014.06.007.

8. Bowman RM. Tethered cord release: a long-term study in 114 patients. J. Ito et all. J Neurosurg Pediatr. 2009; 3: 181-187. doi: 10.3171/2008.12.PEDS0874.

9. Kothbauer KF. Intraoperative neurophysiology of the conus medullaris and cauda equine. Childs Nerv Syst. 2010; 26(2): 247-253. doi: 10.1007/ s00381-009-1020-6.

10. Paradiso G. Multimodality intraoperative neurophysilogic monitoring findings during surgery for tethered cord syndrome: analysis of a series of 44 patients with long-term follow-up. Spine. 2006; 31: 2095-2102. doi: 10.1097/01.brs.0000231687.02271.b6.

11. Sisoev KV. 3-Tl MR-tractografiya caudalnih otdelov spinnogo mozga pri razlichnih formah spinalnih dizraphiy u detey. Luchevaya diagnostika i terapiya. 2016; №2: 52-57. (In Russ). doi:10.22328/2079-5343-2016-2-52-57.

12. Young RL. Symtomatic retethering of the spinal cord following section of a tight filum terminale. Neurosurgery. 2011; 68: 1594-1602. doi: 10.3171/2014.2.peds13528.

13. Rinaldi F. Tethered cord syndrome. J Neurosugery Sci. 2005; 49(4): 131-135. doi: 10.1007/978-3-540-49250-4_25.

14. Deletis V. Intraoperative neurophysiologic monitoring of the spinal cord during spinal cord and spine surgery: a review focus on the corticospinal tracts. Clin Neurophysiol. 2008; 119(2): 248-264. doi: 10.1016/j.clinph. 2007.09.135.

15. Hoving E.W. The value of intraoperative neurophysiologic monitoring in tethered cord surgery Childs nerv Syst. 2011; 27(9): 1445-1452. doi: 10.1007/s00381-011-1471-4.

For citation

Abdullaev D.E., Yugay I.A., Ahmediyev M.M., Ergashev O.F. Features of surgical treatment of the fixed spinal cord syndrome with closed spinal dysraphism. Bulletin of Pirogov National Medical & Surgical Center. 2022;2(17):32-35. (In Russ.) https://doi.org/10.25881/20728255_2022_17_2_32