tethered cord syndrome surgery

In laminar fissures, especially in the lumbosacral region, there are often paravertebral muscles embedded in the defect of the lamina. Local abnormal cartilage, hyperosteogeny, thickening of the ligamentum flavum, epidural scar, and adhesion of the fibers. Scars and adhesions often involve the spinal cord and cauda equina, which cause the spinal segment and its superior and inferior spinal canal stenosis, and also constitute local spinal adhesions, which constitute the tethered cord syndrome. In this case, there is often a thickening of the terminal filament or a combination of lipoma, which is more important for the traction of the spinal cord and the cauda equina. Sometimes the spinal cone is pulled out to the bulging sac and adheres tightly to the wall of the capsule, and the cauda equina is twisted. Therefore, lower limb movement, sensation and limb dysfunction and bladder and anal sphincter dysfunction are produced. The clinical manifestations include partial paralysis of the lower extremities, deformity of the clubfoot, loss of control of the urine or urine, difficulty in urination, and difficulty in defecation. Recessive spina bifida accounts for the majority of spina bifida, often located in the lumbosacral region. The surface of the skin may have pigmentation spots, vasospasm and skin recesses, sinus, subcutaneous fat mass or hair hyperplasia. Most of the simple recessive spina bifida do not show symptoms, and some patients gradually show signs of neurological deficit during development and growth. The pathogenesis is due to the fact that during the development of the embryo, the growth of the spine and the spinal cord is not synchronized, and the growth of the spine is faster than that of the spinal cord, as is the case after birth. At 3 months of normal embryo, the spine is as long as the spinal cord; at 20 weeks, the conical position rises to the level of the lumbar 4 to 5 vertebral body; at 40 weeks, it rises to the waist 3 plane; when the fetus is born, the cone is located at the waist 1 to 2 plane. If the pathological condition of the spina bifida has already existed in the embryonic stage, the spinal conus and the cauda equina will form a tether in the early stage, and the final filament will be shortened accordingly, which will limit the end of the spinal cord and increase with the growth of the spine. As the age increases, the spine becomes longer, and the spinal cord is still fixed in the lesion of the spina bifida. As a result, the spinal cord and the cauda equina are pulled and compressed more and more, and the nerve tissue is ischemic and degenerated. Severe neurological dysfunction. Adults sometimes aggravate traction when the waist is flexed forward, which can suddenly induce symptoms of spinal cord damage. It can be seen that the treatment of this lesion focuses on the surgical removal of spinal stenosis, spinal cord and cauda equina tether, creating conditions for the recovery of neurological function. Treatment of diseases: teratoma, teratoma, teratoma Indication Spinal cord syndrome surgery is applicable to: 1, the different stages of the recessive spina bifida have appeared in the neurological symptoms of the spinal cord. 2, recessive spina bifida combined with intraspinal lipoma, epithelioid cysts and teratomas. Contraindications 1. No special contraindications. 2, asymptomatic simple recessive spina bifida does not require surgery. Preoperative preparation The skin is cleaned daily from 3 days before surgery to prevent the stool from contaminating the surgical area. Those with abnormal hair should be cleaned. Surgical procedure 1. Incision Patients with neurological dysfunction caused by recessive spina bifida, the lesions are mostly located in the lumbar vertebrae, with lumbar 5 and sacral 1, 2 spina bifida are the most common. Generally, a straight incision is made on the spinous process, and the plane of the spine 5 is raised from the lumbar spine to the middle of the atlas. The paraspinal muscles are excised along the spinous processes and the lamina, and the defects of the spinous processes and lamina are revealed. 2, expand laminectomy According to the usual laminectomy method, the spina bifida lesion area and the upper and lower vertebral plates were removed. At the same time, abnormal cartilage, hyperplastic bone, thickened ligamentum flavum, scar, fibrous band and other pathological tissues causing spinal stenosis and spinal cord compression are removed, and the dural sac is fully dissociated, and cerebrospinal fluid fluctuation occurs. Thoroughly relieve spinal cord compression and traction. 3. Cut off the outer end of the spinal capsule and explore the lumbosacral nerve roots on both sides of the meningeal sac. If there is adhesion, it should be freed and released. 4. If the scar tissue adhesion zone leads to the meninges and affects the function of the spinal cord, the dural sac should be opened. Under the operating microscope, the spinal cord and the cauda equina are probed, and the adhesion is sharply separated from the scar. The end of the silk is closely related to the spinal cone. Stop the bleeding carefully, rinse the wound with saline, and tightly suture the dura mater, which is covered with a hemostatic sponge. 5, if the exploration found that there are epithelioid cysts, dermoid cysts or teratomas in the subdural spinal canal, use cotton pads to protect the surrounding area, double-row sutures to pull the tumor wall, cut the tumor capsule in the middle, use scraping Spoon thoroughly scrape the contents of the capsule and rinse it off. The capsule is then freed and the tumor capsule is completely removed as much as possible under a surgical microscope. If the resection is difficult, the tumor capsule and the dura mater can be sutured to make the contents outward to the epidural space. 6, suture muscle layer, subcutaneous tissue and skin surgery range is larger, dura external drainage. The wound is pressure bandaged. complication 1, cerebrospinal fluid leakage. Mainly due to the tight dural suture, and the increase in intracranial pressure. If there is subcutaneous effusion, the effusion can be puncture and then pressurized and bandaged. 2, wound infection. Often the wound is located in the lumbosacral region and is easily contaminated by feces. In the treatment, the contaminated dressing should be replaced in time, and antibiotic treatment should be applied.

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