Magnetic Resonance Evaluation of Pediatric Spinal Dysraphism

Kuharik, Michael A.; Edwards, Mary K.; Grossman, Charles

doi:10.1159/000120254

Cited by 26 publications

(17 citation statements)

References 13 publications

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“…It has offered safe, accurate and reproducible results. Some authors now suggest that the exact location of the tether in relationship to the placode or lipoma can be made using MRI [10,12,13], We have found the MRI less exact.…”

Section: Discussionmentioning

confidence: 72%

Analysis of 153 Patients with Myelomeningocele or Spinal Lipoma Reoperated upon for a Tethered Cord

et al. 1993

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After primary repair of myelomeningoceles or lipomyelomeningoceles, late progressive neurologic deterioration commonly occurs due to a treatable cause. In our experience many of these patients have a tethered cord. With early untethering, most patients are stabilized and a significant percent of the patients show improvement in their clinical status. Of 341 tethered cord releases done from 1981 to 1988, we report on 153 patients reoperated upon following primary repair. One hundred were performed after primary closure of a myelomeningocele and 53 after repair of a lipomyelomeningocele. The average age of the patients with a myelomeningocele was 6 years old, and for the spinal lipoma patients, 8 years old. The presenting symtoms were similar; weakness, deterioration in gait, scoliosis, orthopedic deformities, and urinary incontinence represented the most common complaints. All 153 patients were noted to have a tethered cord at operation. Additional pathology (dermoid tumors, hydromyelia, tight filum and diastematomyelia) was present in 30% of the cases. With the use of the CO₂ laser for dissection, all but 10 patients could be untethered. Follow-up over an average of 4 years revealed 93% of the patients with a myelomeningocele had stabilization or improvement of their presenting complaints, and 7% had progression of their presenting complaints. All of the lipomyelomeningocele patients had either stabilization or improvement of their presenting complaints. There were no mortalities. Close follow-up and early treatment of this patient population is indicated. With release of the cord a significant portion of the population will have relief or improvement of their presenting complaints.

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Section: Discussionmentioning

confidence: 72%

Analysis of 153 Patients with Myelomeningocele or Spinal Lipoma Reoperated upon for a Tethered Cord

et al. 1993

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“…Objective signs are often encumbered by subjec tive symptoms and obscured by associated conditions such as hydromyelia/syringomyelia, diastematomyelia, arachnoid cysts, and dermoid tumors. What is more, nearly all children with spina bifida have low-lying spinal cords, but not all manifest progressive neurologic deterio ration [10][11][12], Conversely the tethered cord syndrome has been described with the conus at a normal level [Oakes, unpubl. data].…”

Section: Introductionmentioning

confidence: 99%

“…Surgery does not always reverse or even stabilize neu rologic deterioration and is certainly not without risk of incurring neurologic injury and impairment of function [13,14], The failure of consistent neurologic improve ment after cord release has fostered a trend toward preemptive surgery, but the lack of correlation between static radiologic imaging and neurophysiologic function provides an inadequate basis for predicting neurologic deterioration and confirming the need for cord release [10,12], In preliminary reports, phase MRI of longitudi nal cord motion have offered some promise of predicting clinical tethering [15,16]. This report expands our initial experience.…”

Section: Introductionmentioning

confidence: 99%

Predicting Outcome in the Tethered Cord Syndrome: A Study of Cord Motion

Johnson

Levy

1995

Pediatr Neurosurg

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Thirty-two children with spinal dysraphism have been studied with phase MRI to assess longitudinal cord motion. Seventeen children who were asymptomatic and who had normal or slightly decreased motion were not operated. Fifteen had signs and symptoms of spinal cord tethering as well as decreased cord motion and underwent surgery. None of the nonsurgical patients have become symptomatic. The children with markedly decreased cord motion did not improve after surgery. A trend was seen toward a better outcome in younger patients with slight or moderate decrease in cord motion. All children with worse outcome were previously operated meningomyeloceles who had markedly decreased cord motion and who were greater than 10 years old.

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“…Consistency would dictate prophylactic surgery in any patient with a tethered cord. At present, magnetic resonance (MR) scanning is the premier imaging tech nique for disclosing and theoretically for monitoring tethering of conus and cauda equina [16]. Real-time ultrasonography has proved useful in some clinics for anatomical definition of this entity [17].…”

mentioning

confidence: 99%

Toward the Prediction of Neurological Injury from Tethered Spinal Cord: Investigation of Cord Motion with Magnetic Resonance

McCullough

Levy

et al. 1990

Pediatr Neurosurg

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Experience with spinal dysraphism has taught that spinal cord tethering will eventually produce neurological deficit. The primary diagnostic and monitoring tool, magnetic resonance (MR) scanning, almost always produces images consistent with cord tethering, even in asymptomatic or improved, previously operated patients. This presents a problem in selecting appropriate candidates for prophylactic intervention. Ideally, a method of monitoring should predict functional deterioration. Real-time ultrasonography, electrophysiological tests, and phase-motion MR studies could potentially be adapted for this purpose. The authors have evaluated the latter technique in both symptomatic and asymptomatic dysraphic patients with tethering. Studies of cervical cord motion show a clear separation between results in patients with cord expansion from hydromyelia and those with pure tethering. Symptomatic patients with progressive deficit or pain have limited cervical cord motion which improves after surgical untethering. MR studies of cord motion have definite promise in the prediction of deficit from spinal cord tethering and should be further evaluated in comparison with ultrasound and electrophysiologic methods.

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Magnetic Resonance Evaluation of Pediatric Spinal Dysraphism

Cited by 26 publications

References 13 publications

Analysis of 153 Patients with Myelomeningocele or Spinal Lipoma Reoperated upon for a Tethered Cord

Analysis of 153 Patients with Myelomeningocele or Spinal Lipoma Reoperated upon for a Tethered Cord

Predicting Outcome in the Tethered Cord Syndrome: A Study of Cord Motion

Toward the Prediction of Neurological Injury from Tethered Spinal Cord: Investigation of Cord Motion with Magnetic Resonance

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