Counting of fetal caudal vertebral body ossification center below terminal conus medullaris in the screening of the closed spine bifida and tethered cord syndrome / 中华超声影像学杂志

Objective:To assess the significance of counting the number of caudal vertebral ossification centers (OCN) below fetal terminal conus medullaris in the screening for closed spina bifida and tethered cord syndrome (TCS).Methods:The OCN was counted in 961 normal fetuses(normal group) between 17 and 41 gestational weeks and in 140 fetuses with closed spina bifida or tethered cord syndrome(abnormal group) from Jan.2013 to Dec.2020 in Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Women and Children′s Hospital, School of Medicine, Xiamen University and Maternity and Child Health Care of Guangxi Zhuang Autonomous Region. The OCN was counted in the dorsal mid-sagittal section of fetal caudal spine.The reliability and agreement test were evaluated by intraclass correlation coefficients in another 50 normal fetuses. The OCN was compared between two groups. ROC curve and the cut-off value were constructed and calculated.Results:In normal group, the N increased with the growing of gestational age.In the subgroup of 17-20 weeks, the OCN ranged from 5 to 7 in most fetuses. In the others subgroups, the OCN was equal to or greater than 6 in 99.9% cases and more than 6 in 97.1% cases. In abnormal group, OCN was less than 7 in 93.0% fetuses and less than 6 in 82.8% cases. There were statistical differences between the two groups except for the subgroup of 17-20 gestational weeks( P<0.05). With the cut-off value of 6.5, the specificity and sensitivity were 93.0% and 94.3% respectively for predicting the presence of closed spinal dysraphism or TCS. Conclusions:OCN is a simple way to evaluate the position of conus medullaris and to screen for the skin-covered spine dysraphism or TSC. OCN is more than 6 in most normal fetuses. Further evaluation of spine is required in fetuses with N less than or equal to 6.

Clinical study of 21 cases of sacral cysts containing fila terminale / 北京大学学报(医学版)

OBJECTIVE@#To summarize the characteristics of sacral cysts containing fila terminale and to explore the surgical treatment methods.@*METHODS@#The clinical features, imaging characteristics and surgical methods of 21 cases of sacral cysts containing fila terminale from July 2010 to March 2017 were reviewed and analyzed. Lumbosacral and perineal pain, weakness of the lower limbs and bladder and bowel dysfunction were the common clinical symptoms. MRI showed that the cysts located in the sacral canal. The lower T1 and higher T2 signals were found on MRI. There were fila terminale within the cysts which tethered the spinal cord. No enhancement was visible within the lesion. The key steps of operation included the resection of the cyst wall, the cutting off of the fila terminale, the release of the tethered cord and the reconstruction of the cisterna terminalis.@*RESULTS@#The total and subtotal resections of cyst walls were achieved in 14 and 7 cases, respectively. The fila terminales were separated and cut off in all the cases, and the tethered cords were released completely. The reconstructions of the cisterna terminalis were accomplished in all the cases. There was no new-onset dysfunction except for 7 cases of mild numbness around anus postoperatively. Pathological examinations confirmed that the cyst wall was fibrous connective tissue, and hyperplasia of fibrous tissue and/or adipose tissue was found within the thickened fila terminale. The lumbosacral and perineal pain disappeared. The weakness of the lower extremities and the bladder and bowel dysfunction gradually improved. The period of follow-up ranged from 3 months to 7 years (average: 2.25 years). The spinal function of all the patients restored to McCormick grade Ⅰ. Only 1 case encountered recurrence of cyst.@*CONCLUSION@#The sacral cysts containing fila terminale are rare. The common symptoms include lumbosacral and perineal pain and symptoms of tethered cord. MRI is helpful to the diagnosis, which shows the signal of cerebrospinal fluid and the fila terminale in the cyst as well as tlow-placed conus medullaris. Microsurgery should remove the cyst wall, cut off the fila terminale, release the tethered cord and reconstruct the cisterna terminalis.

Médula espinal amarrada. Reporte de caso / Case Report: Tethered cord syndrome

We present the case of a 31-year-old patient recent diagnosed with tethered cord syndrome, by MRI, before urgent caesarian section. The image shows the conus medullaris in a low location, reaching L5-S1, which could lead to potential neurological damage if it hadn't been diagnosed. Tethered cord syndrome is a condition in which the spinal cord is enlongated and in a low location, attached to an inelastic structure that holds the conus medullaris, blocking its normal ascension during growth. As a result, the conus medullaris is located below L2 vertebral body, increasing the risk of suffering direct neural damage at spinal anesthesia. Even if direct cord injury can be avoided, the injection of a local anesthetic agent may increase the subarachnoidal preassure leading undirectly to spinal cord damage. The tethered cord is considered to be a contraindication for spinal anesthesia. The incidence of tethered cord is unknown, it can be asymptomatic in adults or present non-specific symptoms, making it difficult to detect before anesthesia. The MRI is the best method for adult diagnosis, allowing us to evaluate the conus medullaris location, injuries and deformations

Presentamos el caso de una paciente de 31 años coordinada para cesárea de urgencia con diagnóstico reciente de médula amarrada (MA) por resonancia magnética. La imagen muestra el cono medular descendido hasta por lo menos L5-S1, exponiéndola a un potencial daño neurológico de no contar con el diagnóstico. Médula amarrada es una condición en la cual la médula espinal se encuentra estirada y descendida por una estructura inelástica que amarra el cono medular, evitando su normal ascenso durante el crecimiento. Como resultado, el cono medular se encuentra por debajo del cuerpo de L2, incrementando el riesgo de lesión directa con la aguja de raquianestesia. Incluso en aquellos pacientes en que la lesión directa no se produce, la inyección del anestésico local puede aumentar la presión subaracnoidea pudiendo provocar una lesión indirecta. La MA es considerada una contraindicación para la anestesia raquídea. La incidencia de MA se desconoce, en adultos puede ser asintomática o presentar síntomas inespecíficos dificultando su diagnóstico preoperatorio. La RNM es el método de elección para el diagnóstico en adultos, permitiéndonos valorar la localización del cono medular, lesiones y malformaciones En neonatos la ultrasonografía puede ser también de utilidad para el diagnóstico.

Small incision surgical treatment for children with tight filum terminale type of tethered cord syndrome / 局解手术学杂志

Objective To explore the efficacy and complications of small insicion surgical treatment and the routine microscopic surgical treatment for children with tight filum terminale type of tethered cord syndrome.Methods According to the clinical manifestations and imaging findings,a total of 43 children with tethered cord syndrome were classified into two groups.Namely the control group (30 cases) who underwent the routine microscopic surgery and the observation group (13 cases) who underwent the small insicion surgical treatment.The difference including prognosis,complications,hospital stays,size of the wound between the two groups were analyzed.Results The 43 children were followed up for 3 to 24 months with an average of 9 months.The results indicated that the postoperative effective rate of the control group was 93.3％,while it was 100％ in the observation group.The difference between the two groups was not statistically significant(P ＞ 0.05).The rate of complications of the control group was 6.67％ whlie it was 0.00％ in the observation group,and the difference of the two groups was statistically significant(P ＜ 0.05).The difference of hospital stays and the size of the wound between the two groups were statistically significant (P ＜ 0.05).Conclusion The small insicion surgical treatment could guarantee the surgical effect for children with tight filum terminale type of tethered cord syndrome,and it can reduce the surgical trauma,post operation hospitalization duration,incidence of complications and intraoperative scar tissues.

Clinical Observation of Chinese Medicine Fumigation-washing Therapy for Treatment of Talipes Equinus Denervated Ulcer Induced by Tethered Cord Syndrome / 广州中医药大学学报

Objective To investigate the clinical effectiveness and safety of Chinese medicine fumigation-washing therapy in treating talipes equinus denervated ulcer induced by tethered cord syndrome(TCS) . Methods A total of 21 qualified patients were randomized into fumigation-washing group (N=12) and antibiotics group (N=9). Patients of fumigation-washing group were given fumigation-washing therapy with the self-prescribed Chinese medicine, and antibiotics group was given intravenous dripping of sensitive antibiotics. The treatment lasted for 7 continuous days. The clinical efficiency of the two groups was evaluated after treatment, and the period of preparing for surgery was recorded. The changes of ulcer area and ulcer surface exudate volume in the two groups were observed before and after treatment. And the changes in blood routine examination, hepatic and renal function, and immune function of the fumigation-washing group were monitored. Results(1) The total effective rate of fumigation-washing group was 83.3％, and that of the antibiotics group was 77.8％, the difference being insignificant (P>0.05). (2) The ulcer area and ulcer surface exudate volume in both groups were significantly decreased after treatment (P 0.05). (5) The average daily hospitalization fee in the fumigation-washing group was (47.98 ± 5.17) yuan, less than (227.88 ± 43.24) yuan in the antibiotics group, and the difference was significant between the two groups (P < 0.05). Conclusion Chinese medicine fumigation-washing therapy is effective, safe and practical in treating talipes equinus denervated ulcer induced by TCS, and the therapy has the advantages of decreasing exudation, promoting ulcer healing, reducing hospitalization fee, shortening the period of preparing for surgery, and decreasing the incidence of infection.

Estahlishment of a tethered cord syndrome model with neural axial stretch in pig / 第二军医大学学报

Objective To explore a method for establishment of tethered cord syndrome model with neural axial stretch in pig. Methods Eighteen adult pigs were randomized into three groups. Sham group: L1-5 spinal cords were exposed; control group: Li-r, bilateral pedicle screws were placed after exposure of L1-5 spinal cords; and experiment group: L1-5 spinal cords were exposed, then bilateral pedicle screws were placed, and finally L1-5 intervertebral spaces were extended axially, with six in each group. At different time points, the pigs in the three groups were subjected to X ray. hindlimb behaviors, urodynamics, somatosensory evoked potential, laser speckle imaging for blood flow and histopathology examination, and the examination results were compared and analyzed. Results In the sham group and control group, there was no obvious change in L1-5 intervertebral space height, hindlimb motor nerve function scores, urodynamics, somatosensory evoked potentials or laser speckle imaging for blood flow before and after operation; and the spinal cord and nerve structure were normal or nearly normal in the histopathology. In the experiment group, compared with before distraction, Liintervertebral height after distraction was significantly increased, hindlimb motor nerve function score was significantly decreased, latency of P-wave of sematosensory evoked potential was significantly extended and the amplitude was significantly decreased, and blood flow 011 the surface of spinal cord was significantly reduced (P

Research Progress of Model Establishment for Tethered Cord Syndrome (review) / 中国康复理论与实践

@# Tethered cord syndrome (TCS) is a progressive neurodevelopmental disorder. The TCS model was established mainly using physical and chemical Methods and surgery, but remained problems in failing to fully reflect the progressive course of the human TCS. In the future, it may select a single etiological factor to analyze, and gradually add other factors until we have deeper understanding of this disease.

Syringohydromyelia in the primary children tethered cord syndrome:magnetic resonance imaging features and correlation analysis / 实用放射学杂志

Objective To summary MRI features of children syringohydromyelia in primary tethered cord syndrome and analyze the correlation.Methods 84 syringohydromyelia cases were analyzed retrospectively.The imaging features of syringohydromyelia including the location,the size and the shape,the syrinx index and so on were analyzed,and the correlation of syringohydromyelia with various diseases which caused tethered cord syndrome were analyzed simultaneously.Results The central canal of the spinal cord was filiform in 1 5 cases,fine tubular in 21 cases and cystic dilatation in 48 cases.There were no relation to the length and width with the age.There was statistically significance in syrinx index(>40%)with diastematomyelia(P =0.017),and no relation to other types of tethered cord syndrome.Diastematomyelia and myelocele were risk factors for cystic dilatation of syringohydromyelia.Conclusion Diastematomyelia and myelocele have a higher incidence in cystic dilatation of syringohydromyelia than that in other types of tethered cord syndrome,and diastematomyelia is more common in association with bigger syrinx index of syringohydromyelia.

Variation in Outcome in Tethered Cord Syndrome

STUDY DESIGN: Fifty patients surgically treated for tethered cord syndrome (TCS) were retrospectively studied at Liaquat National Hospital, Karachi from 2010 until 2014. PURPOSE: To assess the common presentations of TCS in our part of the world and the surgical outcome of the different presentations. OVERVIEW OF LITERATURE: TCS is a stretch-induced functional disorder of the spinal cord with its caudal part anchored by an inelastic structure, which results in characteristic symptoms and signs. Due to the variety of lesions and clinical presentations and the absence of high-quality clinical outcome data, the decision regarding treatment is difficult. METHODS: Fifty consecutive patients with TCS were reviewed retrospectively with a follow-up period of 12–48 months. The majority of the patients were 0-15 years of age with the mean age of 4 years. The presenting complaints and the associated pathologies were documented, and the patients were assessed using the new Karachi TCS severity scale for clinical assessment. RESULTS: Eighty five percent of the patients with thickened filum terminale improved. Sixty six percent of the patients with diastematomyelia, 60% with lipoma and only 46% with myelomeningocele showed clinical improvement postoperatively. Sixty two percent of the patients who presented with paraperesis improved following surgery while 37% remained stable and only one patient deteriorated. Back and leg pain improved in 93% of patients and 50% of patients with urinary impairment improved. CONCLUSIONS: Outcome of patients with TCS varies according to pathology and severity of symptoms. Diastematomyelia and thickened filum had the best outcome. The Karachi TCS severity scale is a valid tool for future studies.

Analysis of surgical effect of adult lipomatous tethered cord syndrome / 中国医师进修杂志

Objective To discuss the surgical effect of adult lipomatous tethered cord syndrome (TCS). Methods The clinical data of 29 patients with adult lipomatous TCS were systematically analyzed. Eleven of male and 18 of female,who ranged from 20 to 59 years. All patients were performed filum terminale release and lipoma excision, the clinical outcome after operation was analyzed according to Hoffman grading criteria and visual analog scale (VAS). Results According to Hoffman grading criteria, 9 cases were obviously improved in leg muscle weakness, including 1 case with urination disturbance improved significantly. Also the lower back pain of patients were improved obviously: (2.63 ± 1.30) scores vs. (8.67±0.30) scores, there was significant difference (P<0.05). Conclusions Filum terminale release and lipoma excision can effectively improve the symptom of lower back pain of adult lipomatous TCS patients, meanwhile the symptom of paraparesis can improve appropriate postoperatively. But urinary deficits do not show a significant change.

Diastematomyelia: A Surgical Case with Long-Term Follow-Up

Few reports have described the involvement of syringomyelia associated with diastematomyelia in the etiology of neurological deficits. We reported a case with syringomyelia associated with diastematomyelia. A female patient with diastematomyelia was followed up clinically over 14 years. At the age of 8, she developed clubfoot deformity with neurological deterioration. Motor function of the right peroneus demonstrated grade 2 in manual muscle tests. Continuous intracanial bony septum and double cords with independent double dura were observed at upper thoracic spine. Magnetic resonance imaging revealed a tethering of the spinal cord and syringomyelia distal to the level of diastematomyelia. Extirpation of the osseum septum and duralplasty were performed surgically. She grew without neurological deterioration during 7 years postoperatively. A long-term followed up case with syringomyelia that was possibly secondary to the tethering of the spinal cord associated with diastematomyelia, and effective treatment with extirpation of the osseum septum and duralplasty was described.

Nerve injury in an undiagnosed adult tethered cord syndrome patients following spinal anesthesia: A case report

Spinal anesthesia is a safe and widely used procedure. Spinal cord injury is a rare but serious complication from spinal anesthesia occurs, unexpectedly. Risks of direct neural injury from spinal anesthesia increase in tethered cord syndrome that the spinal cord is tethered by the inelastic structure and is, also, extended to the lower lumbar vertebra. A 52-years-old female patient undergoing anti-incontinence surgery developed neurologic symptoms following spinal anesthesia. The low-lying conus (L5 body level) and tethered cord were found during the assessment of neurological symptoms.

Fully Endoscopic Interlaminar Detethering of Spinal Cord in Tethered Cord Syndrome: A Case Report and Technical Description

A 19-year-old man presented with long lasting significant back and bilateral leg pain, and hypoesthesia on the lateral side of both his thighs for which he had undergone several courses of medication and bouts of physical therapy treatment. His urodynamic parameters were normal and lumbar magnetic resonance imaging (MRI) revealed a low-lying conus at the L2-3 level with a thickened fatty filum, and he was diagnosed as having tethered cord syndrome (TCS). The patient underwent a fully endoscopic detethering through an interlaminar approach with intraoperative neurophysiological monitoring. The thickened filum terminale was located and then the filum was coagulated and cut. The patient showed a significant improvement in his preoperative symptoms, and reported no problems at 2-year follow-up. Detethering of the spinal cord in tethered cord syndrome using a fully endoscopic interlaminar approach provides the advantages of minimal damage to tissues, less postoperative discomfort, early postoperative recovery, and a shorter hospitalization.

Relative factors analysis on curative effect of children’ s tethered cord syndrome treatment / 局解手术学杂志

Objective To explore the risk factors of surgical treatment for children’ s tethered cord syndrome. Methods Retrospective-ly analyzed the clinical data of 43 tethered cord syndrome children who had undergone surgical treatment from January 2007 to December 2009,and to evaluate the efficacy of the surgical treatment. Meanwhile,The Cox proportional hazards regression model was adopted to evaluate the surgical efficacy. Results 28 children received effctive curative effect after the surgical treatment in 43children with tethered cord syn-drome,the total effective rate was 65. 12%. Cox medol showed that tight filum terminale(P<0. 05), operation methods (P<0. 05)and the duration of the disease(P<0. 05)were independent risk factors of surgical treatment for children’s tethered cord syndrome. Conclusion The operativeefficacy of children’ s tethered cord syndrome were influence by the tight filum terminale,operation methods and the duration of the disease.

Split Cord Malformation Combined with Tethered Cord Syndrome in an Adult

Split cord malformations (SCMs) usually present in childhood, and are rarely reported in adults. And also, a cervicothoracic SCM associated with tethered cord syndrome has very rarely been reported in the literature. We report a case of SCM associated with tethered cord and spina bifida in an adult. This report describes the case of a 34-year-old woman who presented for evaluation of neck pain, back pain, and intermittent paraparesis of several months duration. The MRI and CT showed a SCM at the cervicothoracic level and a fibrous septum at the thoracic level. She underwent surgery for the SCM and tethered cord syndrome, and was followed for 7 years. Patient presented complete recovery in the follow-up. The authors discuss this unusual lesion and describe the anatomical relationship of the level of cord duplication and fibrous septum.

Analysis of Risk Factors and Management of Cerebrospinal Fluid Morbidity in the Treatment of Spinal Dysraphism

OBJECTIVE: Spinal dysraphism defects span wide spectrum. Wound dehiscence is a common postoperative complication, and is a challenge in the current management of cerebrospinal fluid (CSF) leaks and wound healing. The purpose of this study is to evaluate the risks of CSF-related morbidity in the surgical treatment of spinal dysraphism. METHODS: Ten patients with spinal dysraphism were included in this retrospective study. The median age of the cohort was 4.8 months. To assess the risk of CSF morbidity, we measured the skin lesion area and the percentage of the skin lesion area relative to the back surface for each patient. We then analyzed the relationship between morbidity and the measured skin lesion area or related factors. RESULTS: The overall median skin lesion area was 36.2 cm2 (n=10). The percentage of the skin lesion area relative to the back surface ranged from 0.6% to 18.1%. During surgical reconstruction, 4 patients required subsequent operations to repair CSF morbidity. The comparison of the mean area of skin lesions between the CSF morbidity group and the non-CSF morbidity group was statistically significant (average volume skin lesion of 64.4+/-32.5 cm2 versus 27.7+/-27.8 cm2, p<0.05). CSF morbidity tended to occur either when the skin lesion area was up to 44.2 cm2 or there was preexisting fibrosis before revision with an accompanying broad-based dural defect. CONCLUSION: Measuring the lesion area, including the skin, dura, and related surgical parameters, offers useful information for predicting wound challenges and selecting appropriate reconstructive surgery methods.

Study on the morphology and ultrastructure of fetus filum terminale / 国际外科学杂志

Objective The filum terminale(FT)plays an important role in the pathophysiology of tethered cord syndrome(TCS).The study on morphology and structure of fetus FF can provide reference standard for diagnosis of TCS.Methods Ten fresh human aborted fetuses had their fila measured and removed.Transversal and longitudi nal sections of the middle,and distal thirds of FF were submitted to light microscopy analysis with four different techniques.Results The bulk of the Frr is composed of 1～5μm thick spring like longitudinal bundles of colla gen separated by 5～30μm layer intervals and 1～5μm intervals in the layer,although a small quantity of eapillar ies and other elements may be present.Collagen bundles can also be found between layers and bundles.Abundant longitudinally oriented elastic fibers ale found inside or between collagen bundles.Conclusion A complex tridi mensional structure composed by ordered arrangement of spring like fibers and small quantity of capillaries should e licit considerable elastic properties to the FI".Tts alternation of structure and element maybe involved in TCS closely.

Advance of conus medullaris and filum terminal / 国际外科学杂志

Tethered cord syndrome is a severe and congenital disease. Resecting the diseased ilium terminal(FT), eystis, lipoma is the main treatment for the disease, relieving the injury to the eonus medullaris. Why the FT is diseased and thickened? Is it necessary to eut internal FT or external FT? What is the injury mechanism of the low-positional or normal positional oonus medullaris? To study the component and structure of the conus medullaris and FT may give definite answers.

Surgical Management and Outcome of Tethered Cord Syndrome in School-Aged Children, Adolescents, and Young Adults

OBJECTIVE: The adolescent presentation of tethered cord syndrome (TCS) is well-recognized, but continues to pose significant diagnostic and management controversies. The authors conducted a retrospective study of clinical outcomes after surgical intervention in 24 school-aged children, adolescents, and young adults with TCS. METHODS: All 83 patients with a lipomyelomeningocele (LMMC) underwent untethering surgery for caudal cord tethering between 1987 and 2007. The clinical charts and follow-up data were reviewed. Of these patients, 24 school-aged children, adolescents, and young adults with TCS were studied with respect to the clinical, radiologic, pathologic features, and surgical outcomes. RESULTS: Untethering procedures were performed in 24 patients (age range, 7-25 years) for TCS of various origins (lipoma, lipomyelomeningocele, and tight filum terminale). Specific circumstances involving additional tugging of the already tight conus, and direct trauma to the back precipitated the onset of symptom in 50% of the patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities, as well as bladder and bowel dysfunction, were also common findings, but progressive foot and spinal deformities were noted less frequently. The most common tethered lesions were intradural lipomas, thickened filum and fibrous band adhesions into the placode sac. The surgical outcome was gratifying in relation to pain and motor weakness, but disappointing with respect to resolution of bowel and bladder dysfunction. Of the 24 patients with TCS, pre-operative deficits improved after surgery in 14 (58.3%), remained stable in 8 (33.4%), and worsened in 2 (8.3%). CONCLUSION: The pathologic lesions of tethered cord syndrome in school-aged children, adolescents, and young adults, are mostly intradural lipomas and tight filum. It is suggested that the degree of cord traction results in neurologic dysfunction in late life due to abnormal tension, aggravated by trauma or repeated tugging of the conus during exercise. Early diagnosis and adequate surgical release might be the keys to the successful outcome in school-aged children, adolescents, and young adults with TCS.

Influence of tethered cord syndrome on the upper urinary tract and its etiology / 中华泌尿外科杂志

Objective To investigate the influence of tethered cord syndrome (TCS) on the up-per urinary tract and its etiology. Methods Forty patients with TCS diagnosed by spinal MRI were enrolled in this study. There were 21 males and 19 females with mean age of 23 years old. The course of disease ranged from 1 to 40 years. Urinalysis, mid-stream urine culture, serum creatinine(SCr), urinary system ultrasound, IVU, eystography and urodynamic study were carried out on all patients. Results Urinary tract infection was found in 17 patients and increased level of SCr was found in 6 pa-tients (251.64±98.5μmol/L). Of the 29 patients who underwent urinary system ultrasound examina-tion, 12 cases had hydronephroais and dilated upper ureter. Of the 30 patients who underwent IVU, 10(33.3%) had ureterectasia and hydronephrosis, 22 cases had bladder turriform or Christmas tree like deformity with diverticulum and trabeculum. Of the 22 patients accepted cystography, 17 cases had vesieoureteral reflux on 27 sides. Post-void residual (PVR) was evaluated in 35 patients and found increased in 31 cases. Cystometry had been done in 33 patients. The mean value of maximal detrusor pressure (Pdetmax) during filling phase was 41.2±20.9 cm H2O. The detrusor compliance was 22.35±18.8 ml/cm H2O. During voiding phase, detrusor-sphincter dyssynergia(DSD)was observed in 16 patients, detrusor areflexia was observed in 16 patients and detrusor underactivity was observed in 13 patients. Resting urethral pressure profilemetry was measured in 16 patients. Maximal urethral closure pressure (MUCP) was 76.1±33.1 cm H2O. The upper urinary tract deterioration was de-fined as increased SCr, hydronephrosis or vesicoureteral reflux. There were 20 patients diagnosed as upper urinary tract deterioration. The compliance of the upper urinary tract deteriorating group and the no-deteriorating group was 9.4±7.8 vs 19.3±15.8 ml/cm H2O, Pdetmax was 43.1±21.2 vs 24.0±11.9 cm H2O, PVR 189.0±138.0 vs 47.8±36.8 ml, MUCP 86.2±32.4 vs 46.8 5±20.8 cm H2O, incidence of damaged detrusor 100.0% vs 69.2% and DSD 65.0% vs 23.1%, respectively. There were significant differences between the 2 groups(P<0.05). And when comparing the VUR group with no VUR group, the incidence of urinary tract infection was 94.1%(16/17) vs 20.0%(1/ 5) (P=0.003). And when comparing urinary tract infection group with no infection group, the inci-dence of upper urinary tract deterioration was 88.2% (15/17) vs 21.7%(5/23)(P=0.000). Condn-sion Low compliance bladder, high Pdetmax during filling phase, increased PVR, high MUCP, damage of detrusor contractive function and DSD are the risk factors for upper urinary tract deteriora-tion in the TCS patients.