Síndrome da medula presa: registro de dois casos

Machado, Marco Antonio de Oliveira; Lemos, Sérgio; Morais, Josaphat Vilela de

doi:10.1590/S0004-282X1986000200010

Resumos

Registro de dois casos da síndrome de medula presa nos quais o estabelecimento correto do diagnóstico permitiu adotar conduta terapêutica adequada. Esta consiste na ressecção cirúrgica do filum terminale. São comentados aspectos embriológicos e fisiopatogênicos de interesse à síndrome, bem como são analisadas suas manifestações clínicas principais, os exames complementares que possibilitam o diagnóstico, particularmente a mielografia, e aspectos da terapêutica cirúrgica.

The tethered spinal cord syndrome is a disease that ir part of the group of spinal dysraphisms, that was recently recognized as an individualized nosological entity, yet not frequently diagnosed among us. It is characterized by shortenning and thickening of the filum terminale which prevents the ascent of the spinal cord into spinal canal, the conus medularis abnormaly remainning in a low place. It is associated in all cases with spina bifida. The diagnosis is simple, once the disease is suspected. It is manifested by progressive motor or sensory deficit in the legs, urinary incontinence, scoliosis and leg or back pain, specially in young children. The plain lumbosacral RX always shows spina bifida. Myelography makes the diagnostic. It shows, basically, the negative image of the thickened filum terminale and the low placed conus medularis. Other exams which can help are the computadorized tomography and the ultra-sound of the spinal cord. The surgical treatment is very simple and heals without sequels if done in due time. It consists in a sectioning of the filum terminale through laminectomy Two cases diagnosed and treated at Hospital da Baleia, from Fundação Benjamim Guimarães, Belo Horizonte, are reported in this paper.

Síndrome da medula presa: registro de dois casos

Tethered spinal cord syndrome: report of two cases

Marco Antonio de Oliveira Machado^I; Sérgio Lemos^II; Josaphat Vilela de Morais^II

^IResidente de Neurocirurgia - Fundação Benjamim Guimarães, Belo Horionte

^IINeurocirurgião - Fundação Benjamim Guimarães, Belo Horionte

RESUMO

Registro de dois casos da síndrome de medula presa nos quais o estabelecimento correto do diagnóstico permitiu adotar conduta terapêutica adequada. Esta consiste na ressecção cirúrgica do filum terminale. São comentados aspectos embriológicos e fisiopatogênicos de interesse à síndrome, bem como são analisadas suas manifestações clínicas principais, os exames complementares que possibilitam o diagnóstico, particularmente a mielografia, e aspectos da terapêutica cirúrgica.

SUMMARY

The tethered spinal cord syndrome is a disease that ir part of the group of spinal dysraphisms, that was recently recognized as an individualized nosological entity, yet not frequently diagnosed among us. It is characterized by shortenning and thickening of the filum terminale which prevents the ascent of the spinal cord into spinal canal, the conus medularis abnormaly remainning in a low place. It is associated in all cases with spina bifida. The diagnosis is simple, once the disease is suspected. It is manifested by progressive motor or sensory deficit in the legs, urinary incontinence, scoliosis and leg or back pain, specially in young children. The plain lumbosacral RX always shows spina bifida.

Myelography makes the diagnostic. It shows, basically, the negative image of the thickened filum terminale and the low placed conus medularis. Other exams which can help are the computadorized tomography and the ultra-sound of the spinal cord. The surgical treatment is very simple and heals without sequels if done in due time. It consists in a sectioning of the filum terminale through laminectomy Two cases diagnosed and treated at Hospital da Baleia, from Fundação Benjamim Guimarães, Belo Horizonte, are reported in this paper.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Fundação Benjamim Guimarães - Rua Juramento, 1464 - 30280 - Belo Horizonte, MG -Brasil.

1. BARSON, A.J. - The vertebral level of termination of the spinal cord during normal and abnormal development. Radiology 149: 123, 1983.
2. FEDUN, P.C. - Tethered cord syndrome. J. Neurosurg. Nurs. 14: 144, 1982.
3. FITZ, CR. & NASH, D.C.H. - The tethered conus. Amer. J. Roent. Ther. nucl. Med. 125: 515, 1975.
4. GARCEAU, G.J. - The filum terminale syndrome. J. Bone Joint Surg. 35A: 711, 1953.
5. GRYSPEERDT, G.L. - Myelographie assessment of accult forms of spinal dysraphism. Acta Radiol. 35: 711, 1963.
6. HEINS, E.R.; ROSENBAUM, A.E.; SCARFF, T.B.; REIGEL, D.H. & DRAYER, B.P. - The tethered spinal cord following meningomielocele Repair. Radiol. 131: 153, 1979.
7. HILAL, S.K. & KEIM, H.A. - Selective spinal angiography in adolescent scoliosis. Radiology 102 : 349, 1972.
8. HOFFMAN, H. J.; HENDRICK, E.B. & HUMPHREYS, R.P. - The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Child's Brain 2: 145, 1976.
9. JAMES, C.C.M. & LASSMAN L.P. - Spinal dysraphism: the diagnosis and treatment of progressive lesions in spina bifida occulta. J. Bone Joint Surg. 44 : 828, 1962.
10. JONES, P.H. & LOVE, J.G. - Tight filum terminale. Arch. Surg. 73 : 556, 1956.
11. KAPLAN, J.O. & QUENCER, R.M. - The occult tethered conus syndrome in the adult. Radiology 137 : 387, 1980.
12. MERX, J.L.; THIJSSEN, H.O.M. & NIEZEN, S.H.B. - Tethered conus medullaris in metrizanide myelography. Diag. Imag. 52: 179, 1983.
13. RAGHAVENDRA, B.N.; EPSTEIN, F.J. & PINTO, R.S. - The tethered spinal cord: diagnosis by high-resolution real - time ultrasound. Radiology 149: 123, 1983.
14. STREETER, G.L. - Factors involved in the formation of the filum terminale. Amer. J. Anat. 25: 1, 3919.

Datas de Publicação

Publicação nesta coleção
29 Jun 2011
Data do Fascículo
Jun 1986

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BARSON, A.J. - The vertebral level of termination of the spinal cord during normal and abnormal development. Radiology 149: 123, 1983.

[2] 2. FEDUN, P.C. - Tethered cord syndrome. J. Neurosurg. Nurs. 14: 144, 1982.

[3] 3. FITZ, CR. & NASH, D.C.H. - The tethered conus. Amer. J. Roent. Ther. nucl. Med. 125: 515, 1975.

[4] 4. GARCEAU, G.J. - The filum terminale syndrome. J. Bone Joint Surg. 35A: 711, 1953.

[5] 5. GRYSPEERDT, G.L. - Myelographie assessment of accult forms of spinal dysraphism. Acta Radiol. 35: 711, 1963.

[6] 6. HEINS, E.R.; ROSENBAUM, A.E.; SCARFF, T.B.; REIGEL, D.H. & DRAYER, B.P. - The tethered spinal cord following meningomielocele Repair. Radiol. 131: 153, 1979.

[7] 7. HILAL, S.K. & KEIM, H.A. - Selective spinal angiography in adolescent scoliosis. Radiology 102 : 349, 1972.

[8] 8. HOFFMAN, H. J.; HENDRICK, E.B. & HUMPHREYS, R.P. - The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Child's Brain 2: 145, 1976.

[9] 9. JAMES, C.C.M. & LASSMAN L.P. - Spinal dysraphism: the diagnosis and treatment of progressive lesions in spina bifida occulta. J. Bone Joint Surg. 44 : 828, 1962.

[10] 10. JONES, P.H. & LOVE, J.G. - Tight filum terminale. Arch. Surg. 73 : 556, 1956.

[11] 11. KAPLAN, J.O. & QUENCER, R.M. - The occult tethered conus syndrome in the adult. Radiology 137 : 387, 1980.

[12] 12. MERX, J.L.; THIJSSEN, H.O.M. & NIEZEN, S.H.B. - Tethered conus medullaris in metrizanide myelography. Diag. Imag. 52: 179, 1983.

[13] 13. RAGHAVENDRA, B.N.; EPSTEIN, F.J. & PINTO, R.S. - The tethered spinal cord: diagnosis by high-resolution real - time ultrasound. Radiology 149: 123, 1983.

[14] 14. STREETER, G.L. - Factors involved in the formation of the filum terminale. Amer. J. Anat. 25: 1, 3919.