Comprehensive analysis of the clinical and urodynamic outcomes of primary tethered spinal cord before and after spinal cord untethering

Alsowayan, Ossamah; Alzahrani, Ahmad; Farmer, Jean‐Pierre; Capolicchio, John-Paul; Jednak, Roman; El‐Sherbiny, Mohamed

doi:10.1016/j.jpurol.2016.02.012

Cited by 30 publications

(14 citation statements)

References 20 publications

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“…This condition eventually results in ischemic damage of the normal neural tissue of the spinal cord, especially the interneuronal axonal connections requiring aerobic metabolism. 1 Symptoms caused by anatomical TSC include neurological, musculoskeletal, and urological abnormalities. There is general agreement that symptomatic patients with anatomical TSC require surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Impact of magnetic resonance imaging and urodynamic studies on the management of sacrococcygeal dimples

Tamura¹,

Morota²,

Ihara³

2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVESacrococcygeal dimples in neonates and infants are of uncertain pathological import. Previously they were believed to be rarely associated with intraspinal anomalies. Recent studies using MRI, however, revealed that 6%–7% of pediatric cases of sacrococcygeal dimples were associated with anatomical tethered spinal cord (TSC). Because the prevalence of tethered cord syndrome is still unclear, there is no consensus among pediatric neurosurgeons on the management of children with sacrococcygeal dimples. The authors performed an analysis of MRI and urodynamic studies to validate their management strategy for pediatric cases of sacrococcygeal dimples.METHODSA total of 103 Japanese children (49 male and 54 female, median age 4 months, range 8 days–83 months) with sacrococcygeal dimples who were referred to the Division of Pediatric Neurosurgery between 2013 and 2015 were included in this study. The lumbosacral region of all the patients was investigated using MRI. Anatomical TSC was defined as a condition in which the caudal end of the conus medullaris is lower than the inferior border of the L2–3 intervertebral disc. Patients with minor spinal anomalies (e.g., anatomical TSC, filum lipoma, thickened filum, or filar cyst) underwent further urodynamic studies to ascertain the presence of neurogenic bladder (NGB). In this study, the presence of NGB without anatomical TSC but with other minor spinal anomalies was defined as “functional TSC.” The prevalence of anatomical and functional TSC was investigated. The association of the following cutaneous findings with spinal anomalies was also assessed: 1) depth of the dimple, 2) deviation of the gluteal fold, and 3) other skin abnormalities (e.g., discoloration, angioma, or abnormal hair).RESULTSThe children were classified into 4 groups: Group 1, patients with anatomical TSC; Group 2, patients with functional TSC; Group 3, patients without anatomical or functional TSC but with other minor spinal anomalies; and Group 4, patients with no spinal anomaly. There were 6 patients (5.8%) in Group 1, 8 patients (7.8%) in Group 2, 10 patients (9.7%) in Group 3, and 79 patients (76.7%) in Group 4. Twenty-four patients (23.3%; Groups 1, 2, and 3) showed MRI abnormalities, including filum lipoma (14 cases), filar cysts (5 cases), thickened filum (2 cases), and anatomical TSC without other spinal anomalies (3 cases). Untethering of the spinal cord was indicated for 14 patients (13.6%; Groups 1 and 2) with anatomical and functional TSCs. Preoperative NGB was found in 12 patients and improved postoperatively in 7 (58.3%). None of the associated lumbosacral skin findings predicted the presence of underlying spinal anomalies.CONCLUSIONSThe prevalence of tethered cord syndrome among children with sacrococcygeal dimples was, for the first time, revealed to be higher than previously thought. MRI and supplemental urodynamic studies may be indicated for children with sacrococcygeal dimples to identify patients with symptomatic TSC.

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Section: Discussionmentioning

confidence: 99%

Impact of magnetic resonance imaging and urodynamic studies on the management of sacrococcygeal dimples

Tamura¹,

Morota²,

Ihara³

2017

Journal of Neurosurgery: Pediatrics

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“…Furthermore, the influence of age and meningitis could not be ignored. However, there were two reports suggesting the association of syringomyelia and urological outcomes in pediatric TSC; LUT function improved in just 30% of cases with syringomyelia after untethering surgery, whereas it improved in 86% of cases without syringomyelia . This might suggest that, in cases of TSC in association with ASM, syringomyelia indicates that the LUT symptoms cannot be cured with surgery alone.…”

Section: Summary Of the Present Case And Five Previous Cases Of Asm Wmentioning

confidence: 98%

Association of syringomyelia with lower urinary tract dysfunction in anterior sacral meningocele with a tethered spinal cord: A case report and literature summary

et al. 2018

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“…TCS may cause neurologic bladder and other clinical or subclinical urinary disturbances [10,11]. Since bladder or sphincter dysfunctions or malformations are also commonly observed in individuals with scoliosis, an abnormal UDS finding is not always associated with the presence of TCS [12].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Abnormal Urodynamic Study Results in Patients with Congenital and Idiopathic Scoliosis and Its Predictive Value for the Diagnosis of Tethered Cord Syndrome: A Single Institution Clinical Study

et al. 2021

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Study Design:A total of 110 patients with scoliosis were enrolled in this analytical cross-sectional study. Purpose: We aimed to compare the urodynamic study (UDS) results of patients with idiopathic scoliosis (ISC) and congenital scoliosis (CSC) and to evaluate the clinical significance of abnormal UDS findings in predicting underlying tethered cord syndrome (TCS). Overview of Literature: An abnormal UDS finding is commonly found in patients with CSC. However, there is no consensus regarding its prevalence in patients with ISC. Methods: Using the STROBE checklist for cross-sectional studies, 110 patients with scoliosis were selected based on our inclusion and exclusion criteria. Among the patients, 76 presented with ISC and 34 with CSC. Demographic data and other details, such as the results of spine radiography, UDS, and magnetic resonance imaging of the spine in both supine and prone positions, were recorded and analyzed. Results: Approximately 50% of patients with CSC had normal UDS findings; 8.8%, mild impairment; and 41.2%, significant abnormalities. Moreover, 67.1% of patients with ISC had normal UDS findings; 9.2%, mild impairment; and 23.7%, significant abnormalities (p=0.166). TCS was identified in 38.2% and 26.3% of patients with CSC and ISC, respectively (p=0.571). In patients with ISC, a significantly abnormal UDS finding indicated that the risk of TCS increased from 26.3% to 50% (odds ratio [OR], 4.2; p=0.009). Meanwhile, in patients with CSC, the risk was almost similar (OR, 0.8; p=0.8). Conclusions:Even with the absence of subjective urinary symptoms, subclinical urologic impairments can be observed in a significant number of patients with ISC. An abnormal UDS finding can be a sign of underlying spinal cord tethering in a patient with ISC who is a candidate for corrective spine surgery even though it is an independent variant and is not exclusive to candidates for surgery. This finding has high clinical utility for neuro-and ortho-spine surgeons who aim to correct scoliosis (OR, 4.2; p=0.009).

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Comprehensive analysis of the clinical and urodynamic outcomes of primary tethered spinal cord before and after spinal cord untethering

Cited by 30 publications

References 20 publications

Impact of magnetic resonance imaging and urodynamic studies on the management of sacrococcygeal dimples

Impact of magnetic resonance imaging and urodynamic studies on the management of sacrococcygeal dimples

Association of syringomyelia with lower urinary tract dysfunction in anterior sacral meningocele with a tethered spinal cord: A case report and literature summary

Prevalence of Abnormal Urodynamic Study Results in Patients with Congenital and Idiopathic Scoliosis and Its Predictive Value for the Diagnosis of Tethered Cord Syndrome: A Single Institution Clinical Study

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