Perioperative care of pediatric patients with tethered cord syndrome / 中国实用护理杂志

Objective To discuss perioperative nursing of pediatric patients with tethered spinal cord syndrome (TCS). Methods 35 pediatric patients with TCS underwent surgical treatment. Pre-operative nursing included psychological care for the parents to eliminate their fear and worries, prona-tion position practice and clean of skin for the children patients, post- operative care included monitor-ing of vital signs, maintaining of proper positions,close observation of the wound, skin care and rehabili-tation training. Results After intensive care, all cases went through the perioperstive period without bed sores. During follow- up disappearance of clinical symptoms occurred in 24 cases, 3 cases got allevia-tion,7 cases with no improvement, and 1 case with deteriorated clinical symptom. Conclusions Preopera-tive care for patients with tethered cord syndrome can provide doctors with the diagnosis and treatment reference, and it plays an important role in treatment and rehabilitation of children patients.

Síndrome de médula espinal anclada en un cachorro bulldog inglés. Reporte de un caso / Síndrome de medula amarrada em um cão da raça bulldog inglês. Reporte do caso / Tethered spinal cord syndrome in an english bulldog puppy. A case report

El síndrome de médula espinal anclada es una patología del desarrollo diagnosticada en seres humanos pero de poco reporte en medicina de pequeñas especies animales. En este artículo se presenta un caso de disrafismo espinal, vértebra lumbar supernumeraria, espina bífida con meningocele, médula espinal anclada y seno dermoide en un cachorro de raza bulldog inglés de cuatro meses de edad, que presentó un cuadro clínico de incontinencia fecal, atrofia muscular en miembros pelvianos y ataxia. Se describe el procedimiento diagnóstico, el tratamiento y la evolución clínica del paciente. Con este reporte se pretende que el médico veterinario considere dentro de sus diagnósticos diferenciales la posibilidad de una afección de tipo neurológico cuando el paciente presente signos clínicos tipo incontinencias fecal y urinaria, ataxia y debilidad de miembros pelvianos, en perros de razas con predisposición a sufrir este tipo de síndrome; además, llamar la atención sobre este tipo de patologías que en la mayoría de los casos podrían ser subdiagnosticadas.

Tethered spinal cord syndrome is a developmental disease diagnosed in human but of rare report in small animal practice. In this report a case of spinal disrafism, spina bifida with menyngocele, tethered cord syndrome and dermoid sinus is described in a four months old English bulldog male, that presented a clinical condition of faecal incontinence, muscular atrophy in pelvic limbs and ataxia. The diagnostic procedure, treatment and evolution of the patient are described. The purpose of this report is to provide the practitioner with diagnostic tools to include a neurological entity as a differential diagnosis when attending a patient presenting clinical signs such as fecal and urinary incontinency, ataxia and pelvic limbs debility, in dogs of breeds predisposed to suffering this syndrome; in addition, to highlight this neurological pathologies that could be under diagnosed in most of the cases.

E síndrome de medula amarrada é uma doença diagnosticada em desenvolvimento humano, mas de rara incidência em prática dos pequenos animais. Neste relatório o caso clinica de disrafismos do tubo neural, espinha bífida com meningocele, e síndrome de seios dermoides são descrito em um cão da raça bulldog inglês de quatro meses de idade, que apresentou uma condição clínica de incontinência fecal, atrofia muscular nos membros pélvicos e ataxia. O procedimento diagnóstico, tratamento e evolução do paciente são descritos. O objetivo do presente articule consiste em fornecer o praticante com ferramentas diagnósticas para incluir uma entidade neurológica como um diagnóstico diferencial quando freqüenta um doente apresentar sinais clínicos tais como incontinência fecal e urinária, ataxia e debilidade de membros pélvicos, em cães de raças predispostas a este síndrome; além disso, para destacar estas patologias neurológicas que poderiam estar sob diagnosticada na maioria dos casos.

MRI manifestations of Neurogenic Bladder due to Tethered Spinal Cord / 中国康复理论与实践

@#Objective To analyze MRI features of neurogenic bladder caused by tethered spinal cord. Methods MRI manifestations of 22 patients with neurogenic bladder due to tethered spinal cord were retrospectively analyzed.Results & Conclusion MRI can display the position of the spinal cord and the cause of tethered cord syndrome. Spinal deformations can also be displaied clearly. The characteristic signs of neurogenic bladder due to tethered spinal cord were the lower position of medullary cone (below L1～L2) and localized thickening or protrusion of the bladder wall.

Evaluation of "free sacro-capsule"for the tethered spinal cord syndrome by urodynamic examination / 中国矫形外科杂志

[Objective]To use urodynamic method to evaluate "free sacro-capsule"pre-operation and post-operation effect,also evaluate bladder and urethral function.[Method]Twenty children were included in this study.[Result]All children had none damage after operation.The PVR and DLPP of post-operative group are significantly decreased.The BC and MCC of post-operation group was significantly higher than pre-operation group(P

Outcome of Surgical Treatment for Lipomeningomyelocele

Lipomeningomyelocele(LMMC) is one of the most common forms of occult spinal dysraphism seen in clinical practice. It is now widely accepted that prophylactic surgery is indicated in most cases, but areas of controversies were remained. From January 1986 to December 1996, long term data are available for 57 patients who underwent surgery for LMMC repair. The most common presenting symptom of these patients were mass on back which was followed by weakness of lower extremities and bladder-bowel symptoms. Transitional type was most common(53%) and followed by caudal(28%) and dorsal type(19%). Surgical repair was performed at age of 1 month to 40 years(mean age: 48months old, median 5 months old). Follow up for these patients ranged from 10 to 130 months(mean 50.3 months). None of the patients who underwent surgery before deficits had occured had ever developed new neurological deficits at the end of the follow up. However, 8 of 57 patients(14%) had aggravation of thier initial neurologic status by history preoperatively. Those progressive symptoms were somewhat reversed or stabilized in all of them postoperatively. In addition, surgical correction in infancy provides a degree of reversibility but do not in older children. We concluded that early diagnosis and treatment should be taken to prevent these progression and permanency of neurological changes.

Neurogenic Bladder in the Patients with Tethered Cord Syndrome: A case report

Tethered spinal cord syndrome can be defined as a low conus medullaris extending below L2 vertebral level and/or a thickened filum terminale above 2 mm in diameter. Among the neurologic symptoms, neurogenic bladder and bowel is the most common and leaves significant sequale that the patients being disabled not physically but socially. Early recognition and detethering operation are recommended but proper bladder management with regular follow-up should be accompanied for better prognosis. Here, three cases of the neurogenic bladder with tethered spinal cord syndrome who primarily had myelodysplasia are presented with review of the articles.

MRI Diagnosis of Tethered Spinal Cord Syndrome / 实用放射学杂志

Objective To study the MR features and diagnostic value of tethered cord syndrome(TCS).Methods MR findings of 30 cases with TCS were reviewed.All cases were confirmed by operation and pathology.Results In 30 cases,the levels of the tips of the conus were below the middle of L 2 vertebral body.Spinal cords were fixed as result of being drawn.MR findings were as follows:Single thickened and tightened filum terminale(4 cases,13%);Lipoid buld(13 cases,43%);Myeloey stocele(3 cases,10%);Meningcele(4 cases,13%);Tumor in spinalcannal(6 cases,20%) Included neurofibroma (2 cases),dermoid cyst (2 cases) and epidermoid (1 cases),teratoma(1 cases).Conclusion MRI with high soft tissue resolution and mutiple sections imaging is superior to any other imaging means,it can clearly demonstrate the position and shape of the spinal cord conus as well as the associated malformation.

A Tethered Spinal Cord with Intraspinal Lipoma in a 40-year-old Woman who has Intractable Pain of the Foot: Case Report

A 40-year-old female patient who had tethered spinal cord with intraspinal lipoma and intractable pain of the lower leg and foot is reported. The pain started 5 years ago and exaggerated recently. A pea-size mass had been noted since birth at sacral region, which was excised 2 months prior to admission at the other clinic. Neurological examination revealed diffuse muscular wasting of the left foot, especially the sole, hypesthesia of the left sole with dysesthesia, bilaterally increased knee jerks, and absent left ankle jerk. The patient underwent L5 laminectomy, subtotal removal of extradural, intradural and intramedually lipoma with dural repair, and dorsal rhizotomy of ipsilateral L5 and S1 roots. At surgery, the neural elements were untethered with mass removal, adhesiolysis, and division of thickened arachnoid septum. The pain improved much after and was tolerable with some analgesics.