Nuâncias Cirúrgicas da Estimulação da Medula Espinhal na Dor Neuropática Refratária na Síndrome da Medula Ancorada. Relato de caso e revisão de literatura

A síndrome da medula ancorada é decorrente de alterações estruturais na medula espinhal caudal, resultando em sua aderência e desenvolvimento inadequado, sendo raro em adultos e, consequentemente, são escassas as informações disponíveis na literatura. O tratamento pode ser cirúrgico ou por meio da colocação de eletrodos medulares para a redução da dor. O objetivo desse estudo foi relatar um caso de rara apresentação clínica da síndrome em um indivíduo adulto e avaliar as modalidades de tratamento e seus desfechos clínicos, bem como a eficácia da estimulação por meio de eletrodos medulares. Foram realizados um relato de caso e uma revisão de literatura, dos bancos de dados PubMed, Medline e CAPES, entre 2016 e 2020. Dos 41 artigos encontrados, 12 foram incluídos. O tratamento cirúrgico deve ser realizado o mais precoce possível em pacientes sintomáticos. Dentre as modalidades disponíveis, a minimamente invasiva se mostrou mais satisfatória e com menores riscos de complicações. O uso de eletrodo impacta significativamente na melhora da dor e na qualidade de vida de modo geral. A utilização de eletrodo placa penta e a cirurgia minimamente invasiva em adultos apresentam resultados satisfatórios em relação à dor do paciente, principalmente quando comparado à cirurgia convencional.

Anchored cord syndrome is due to changes in the caudal spinal cord, delay in its adherence and triggered development, being rare in adults and, consequently, there is little information available in the literature. Treatment can be surgical or through the placement of spinal electrodes to reduce pain. The aim of this study was to present a case of rare clinical presentation of the syndrome in an adult individual and evaluate the treatment modalities and its clinical outcomes, as well as the efficacy of stimulation through spinal cord electrodes. A case report and a literature review were carried out, in PubMed, Medline and CAPES databases, between 2016 and 2020. Of the 41 articles found, 12 were included. Surgical treatment should be performed as early as possible in symptomatic patients. Among those available, the minimally invasive one proved to be more satisfactory and with less risk of complications. The use of electrodes has an impact due to the improvement in pain and quality of life in general. The use of a penta-plate electrode and minimally invasive surgery in adults present satisfactory results in terms of patient pain, especially when compared to conventional surgery.

1.    Safaee MM, Winkler EA, Chou D. Mini-open spinal column shortening for the treatment of adult tethered cord syndrome. J Clin Neurosci. 2017;44:315-9. http://dx.doi.org/10.1016/j.jocn.2017.07.037. PMid:28789957.
2.    Gao J, Kong X, Li Z, Wang T, Li Y. Surgical treatments on adult tethered cord syndrome A retrospective study. Medicine (Baltimore). 2016;95(46):e5454. PMid:27861396.
3.    Jackson C, Yang BW, Bi WL, Chiocca EA, Groff MW. Adult Tethered Cord Syndrome Following Chiari Decompression. World Neurosurg. 2018;112:205-8. http://dx.doi.org/10.1016/j.wneu.2018.01.165. PMid:29409774.
4.    Shukla M, Sardhara J, Sahu RN, et al. Adult versus pediatric tethered cord syndrome: clinicoradiological differences and its management. Asian J Neurosurg. 2018;13(2):264-70. http://dx.doi.org/10.4103/1793- 5482.228566. PMid:29682019.
5.    Son HS, Kim JH. Urological presentations of adult primary tethered cord syndrome. Neurourol Urodyn. 2020;39(2):633-41. http://dx.doi. org/10.1002/nau.24231. PMid:31782978.
6.    Son HS, Soto Troya I, Jeon YJ, Kim MJ, Kim SW, Kim JH. Mp17-05 urodynamic parameters and urological presentation differ depending on Symptom Onset in Adult Primary Tethered Cord Syndrome. J Urol (Internet). 2016;195(4S):e185-6. http://dx.doi.org/10.1016/j. juro.2016.02.2673.
7. Rai HH, Khan MF, Enam SA, Hashmi I. Co-existing spinal intradural ependymal cyst and sacral Tarlov cyst in adult-onset tethered cord syndrome with syringomyelia: case report and literature
review. Surg Neurol Int. 2016;7(26, Suppl 25):S708-10. http://dx.doi. org/10.4103/2152-7806.191083. PMid:27843691.
8.    Xu F, Wang X, Li L, Guan J, Jian F. Tethered Cord Syndrome Caused by Duplicated Filum terminale in an Adult with Split Cord Malformation. World Neurosurg. 2020;143:7-10. http://dx.doi. org/10.1016/j.wneu.2020.07.100. PMid:32711136.
9.    D’Agostino EN, Calnan DR, Makler VI, Khan I, Kanter JH, Bauer DF. Type I split cord malformation and tethered cord syndrome in an adult patient: a case report and literature review. Surg Neurol Int. 2019;10(90):90. http://dx.doi.org/10.25259/SNI-66-2019. PMid:31528428.
10.    Veronesi V, Sacco C, Mastronicola C, Staffa G. Transhiatal approach to filum terminale externum sectioning in adult patient with tethered cord syndrome: case report. Oper Neurosurg (Hagerstown). 2018;15(1):E1-4. http://dx.doi.org/10.1093/ons/opx188. PMid:28961973.
11.    Novik Y, Vassiliev D, Tomycz ND. Spinal cord stimulation in adult tethered cord syndrome: case report and review of the literature. World Neurosurg. 2019;122:278-81. http://dx.doi.org/10.1016/j. wneu.2018.10.215. PMid:30415046.
12.    Liu JJ, Guan Z, Gao Z, Xiang L, Zhao F, Huang SL. Complications after spinal anesthesia in adult tethered cord syndrome. Medicine (Baltimore). 2016;95(29):e4289. http://dx.doi.org/10.1097/MD.0000000000004289. PMid:27442670.