Etiology Various congenital developmental abnormalities of the spinal cord and spinal ends can lead to spinal cord embolism, such as occult spina bifida, spondylolisthesis, spinal cord spondylolisthesis, spinal cord end filament tension, lumbosacral intraspinal lipoma, congenital cysts, and latent hair sinus. In addition to the aforementioned congenital factors, postoperative adhesions in the lumbosacral spinal bulge can also lead to spinal cord reembolization. It is generally believed that spinal cord embolism causes blood circulation disorders at the end of the spinal cord, resulting in the corresponding neurological symptoms. Clinical manifestations The clinical manifestations of spinal cord embolism syndrome are similar to those of spina bifida and include the following: lumbosacral skin changes lumbosacral skin bulges or depressions, possibly with discharge or infection; hirsutism; large bulging masses. These predict the presence of occult spina bifida, latent hair sinus, and spinal bulge, which may be combined with spinal cord embolism. The figure on the right shows one of the common skin abnormalities. Motor disorders of the lower extremities: manifested by abnormal walking, weakness, deformity and pain of the lower extremities, which may also be combined with scoliosis. Sensory disorders of the lower extremities: abnormal sensation and pain in the lower extremities, perineum and low back. Urinary and fecal dysfunction: common manifestations include urinary retention, difficulty in urination, incontinence, more frequent urination with less than normal volume each time, etc.; constipation, constipation, or incontinence. Diagnosis and treatment Magnetic resonance imaging is the main method to diagnose spinal cord embolism, it can not only clarify the presence of spinal cord embolism, but also other coexisting pathological changes, such as lipoma, spinal cord longitudinal bifida, etc. X-ray can determine the presence of spina bifida. Urological ultrasound and urodynamics are performed to evaluate the degree of urinary tract involvement and spinal cord neurological impairment in conjunction with urinary and fecal function. The right image shows the MRI image of a patient with spinal cord embolism. The normal spinal cord ends at the lower edge of the 1st lumbar vertebra, but in this patient, the spinal cord ends are lowered to the level of the 5th lumbar vertebra. Treatment】 Surgery to release the embolus and remove the lipoma and other lesions. Principles of treatment 【Our principles of surgical treatment for spinal cord embolism syndrome】 The spinal cord embolism has been organically altered by the time symptoms appear, and we cannot restore it to normal, but can only treat it appropriately so that it does not progress. The symptoms of spinal cord embolism syndrome may be the result of destructive damage to the nervous system, which is usually irreparable, and treatment is simply to stop the damage from getting worse. It may also be the result of irritative or incomplete damage to the nervous system, where surgery may have the dual effect of reducing symptoms and preventing progression. Therefore, the fundamental purpose of surgical treatment of spinal cord tethering syndrome (spinal cord tethering syndrome) is to prevent the progression of the disease, and some patients may have improved motor and sensory functions of the lower extremities, and even urinary and fecal functions as a result. Surgery usually does not improve the deformities of the lower extremities and feet, but it may improve pain and incomplete muscle strength loss to some extent. The deformities of the lower extremities and feet can be partially improved by orthopedic surgery. Therefore, for many patients with spinal cord embolism syndrome, especially in children, a combination of spinal cord spine surgery or neurosurgery, urology and orthopedic surgery is required. For patients with normal spinal cord embolism, including those with skin changes in the lumbosacral region and sensory and motor deficits in the lower extremities, early systematic examination, evaluation, and surgery are recommended; for patients who already have urinary and fecal dysfunction, surgery should be selected in the context of their general condition and relevant investigations, and most of these patients can and need surgery. Patients should be operated with the concept of minimally invasive surgery, insist on microsurgery, and cooperate with neurophysiological monitoring if necessary, in order to release the embolism as completely as possible, avoid nerve damage, reduce re-adhesion and embolism, and prevent postoperative wound complications. Postoperative patients are followed up and given the best possible guidance on the prevention and treatment of urinary tract dysfunction, rehabilitation of lower limb movement and sensation, and correction of lower limb deformities. We believe that focusing solely on embolization surgery and neglecting proper guidance for the continued treatment of these dysfunctions is detrimental to the patient.