Table of Contents

HK J Paediatr (New Series)
Vol 8. No. 4, 2003

HK J Paediatr (New Series) 2003;8:318-321

Paediatric Surgical Forum

Untethering of the Tethered Cord with Spina Bifida: Experience in the Prince of Wales Hospital, Hong Kong

XL Zhu, HT Wong, WS Poon, CK Yeung


The outcomes of 40 spina bifida cases undergone untethering surgery in the Prince of Wales Hospital with a mean follow-up of 4.5 years were reviewed. There were 11 cases with lipoma of filum (4 asymptomatic) and 29 cases with lipoma of conus (10 asymptomatic). The surgical complication rate was zero for the filum lipoma group, 17.2% local complication and 3.4% neurological complication for the conus lipoma group. For the long-term outcomes of the asymptomatic patients, all remained asymptomatic except one case. In symptomatic patients with filum lipoma and conus lipoma, the respective long-term outcomes were 29% and 37% improved, 57% and 53% stable and 14% and 11% deteriorated. The results are consistent with current international data. The results strengthen our policy to recommend untethering surgery for all young children with tethered cord and for patients of all ages who are deteriorating neurologically due to tethered cord. For older children who are asymptomatic or with stable neurological deficit, untethering surgery will be an option opened to the parents and patient.

本文總結了收住威爾斯親王醫院的 40 例脊柱裂病例採用鬆解術並平均隨訪 4.5 年的病況結果。包括 11 例絲狀脂肪瘤患者(4 例無症狀)和 29 例塊狀脂肪瘤患者(10 無症狀)。在絲狀脂肪瘤組,外科併發症為零,塊狀脂肪瘤組, 17.2% 有局部併發症,3.4% 有神經系統併發症。無症狀患者長期隨訪結果是僅有一例出現臨床症狀,在絲狀脂肪瘤及塊狀脂肪瘤長期隨訪結果為,各有 29% 和 37% 改善,57% 和 53% 病情穩定,14% 和 11% 病情惡化。本研究結果同近年來國外報導相符。該結果支持我們的措施,即對所有有髓索受壓的幼兒及各年齡階段病人因髓索受壓出現神經系統退化的推薦鬆解術。對無症狀或神經系統退變穩定的大年齡兒,鬆解術可供家長和患兒選擇。

Keyword : Spina bifida; Spinal dysraphism; Spinal lipoma; Tethered cord



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