Screening and Treatment of Tethered Spinal Cord in Anorectal Malformation Patients

Hondel, Desiree van den; Sloots, Cornelius E. J.; Jong, T. H. R. de; Lequin, Maarten H.; Wijnen, René

doi:10.1055/s-0035-1563673

Cited by 16 publications

(3 citation statements)

References 20 publications

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“…The association between ARM and SD has been widely documented in the literature [2,5,10]. The high variability over the years in the reported incidence and in the surgical approach to this spinal anomaly is mainly due to the evolution of the diagnostic and therapeutic techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with anorectal malformations (ARM) often present with associated anomalies of the spectrum of the VACTERL association, which includes spinal and/or vertebral defects (V), anorectal malformations (A), congenital cardiac anomalies (C), esophageal atresia/tracheoesophageal fistula (TE), renal and urinary abnormalities (R), and limb lesions (L) [1]. In particular, spinal dysraphism (SD) has been reported in up to 46% of the patients with ARMs [2,3]. Therefore, neonates with ARM are screened at birth for the possible association with the above anomalies, and a spinal ultrasound (US) is performed in the neonatal period to detect spinal anomalies, confirmed or not by magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

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Impact of the associated anorectal malformation on the outcome of spinal dysraphism after untethering surgery

et al. 2018

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Purpose To analyze the outcome after untethering surgery in patients with spinal dysraphism (SD), with or without associated anorectal malformation (ARM). Methods Patients operated on for SD, with (Group A) or without (Group B) associated ARM (1999ARM ( -2015, were included. The post-operative outcome was analyzed in the two groups in terms of improving of clinical symptoms (neuro-motor deficits, bladder dysfunction, bowel dysfunction) and of instrumental examinations (urodynamics, bladder ultrasound, neurophysiology). Fisher's exact test and χ 2 test were used as appropriate; p < 0.05 was considered statistically significant. Main results Ten patients in Group A and 24 in Group B were consecutively treated. One patient was lost at follow up. Six patients (25%) in Group B underwent prophylactic surgery. The analysis of the pre-operative symptoms in the two groups showed that a significantly higher number of patients in group A needed bowel management and presented with neuro-motor deficits, compared to group B (p = 0.0035 and p = 0.04, respectively). Group A showed a significant post-operative neuromotor improvement as compared to group B (p = 0.002). Conclusions Based on our results, untethering seems to be effective in neuro-motor symptoms in selected patients with ARM. In ARM patients, untethering surgery does not seem to benefit intestinal and urinary symptoms. The presence of the associated ARM does not seem to impact the medium-term outcome of patients operated for SD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of the associated anorectal malformation on the outcome of spinal dysraphism after untethering surgery

et al. 2018

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“…In the Rohrschneider et al study, spinal disorder findings diagnosed in ultrasonography of 30 babies with a mean age of 5.5 months were consistent with MRI findings; in all cases of abnormalities, the diagnoses were the same ( 11 ) Also, in Sattar’s study, the use of prenatal ultrasonography in diagnosis of spina bifida led to favorable results in post-natal follow-up by MRI, so that in all eight infants under study, ultrasonography had diagnosed prenatal spina bifida ( 12 ). In the latest studies in 2015, the Hondel et al study showed that ultrasonography had a sensitivity of 80% and specificity of 89% in diagnosing tethered cord ( 13 ). One of the other items not mentioned in other studies, which has been examined for the first time in this study, is the relationship between spinal cord abnormalities findings in patients with neurogenic bladder on MRI with ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of ultrasonography in spinal abnormalities among children with neurogenic bladder

et al. 2017

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BackgroundNowadays, magnetic resonance imaging (MRI) is the gold standard for evaluation and diagnosis of spinal cord abnormalities, which are considered among the leading causes of neurogenic bladder; however, MRI is a costly imaging method and is not available at all health centers. Sporadic studies have shown the alignment of MRI with ultrasonography results in diagnosis of spinal abnormalities; although none of these studies has expressed the diagnostic value of ultrasonography.ObjectiveThe aim of this study was to evaluate the diagnostic value of ultrasonography in detection of spinal abnormalities in children with neurogenic bladder.MethodsThis is a cross-sectional study carried out from January 2014 to November 2015 on patients with neurogenic bladder referred to Department of Radiology, Dr. Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. All patients underwent sonography of the spinal cord and soft-tissue masses; also, a spinal MRI scan was performed. The existence of spina bifida, sacral agenesis, posterior vertebral arch defects, mass, tethered cord, myelomeningocele, lipoma and fatty infiltration, dural ectasia, hydromyelia and syringomyelia, and diastomatomyelia was recorded during each imaging scan. Chi-square and Fisher’s tests were used for data analysis using SPSS 19.0 software, and the sensitivity and specificity of ultrasonography findings were calculated by MedCale 26 software.ResultsForty patients with neurogenic bladder (22 males/18 females), with an average of 25.73±19.15 months, were enrolled. The most common abnormality was found in patients’ MRI was tethered cord syndrome (70%). There was a significant relationship between ultrasonographic and MRI findings in spina bifida abnormalities (p=0.016), sacral agenesis (p=0.00), tethered cord (p=0.00), myelomeningocele (p=0.00), and lipoma and fatty infiltration (p=0.01). Ultrasonography had a sensitivity of 20.0%–100% and a specificity of 85.7%–100% depending on the detected type of abnormality.ConclusionIt seems that ultrasonography has an acceptable and desirable sensitivity and specificity in the diagnosis of most of the spinal cord abnormalities in children with a neurogenic bladder.

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Anorectal malformations associated spinal cord anomalies

et al. 2016

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Screening and Treatment of Tethered Spinal Cord in Anorectal Malformation Patients

Cited by 16 publications

References 20 publications

Impact of the associated anorectal malformation on the outcome of spinal dysraphism after untethering surgery

Impact of the associated anorectal malformation on the outcome of spinal dysraphism after untethering surgery

Diagnostic value of ultrasonography in spinal abnormalities among children with neurogenic bladder

Anorectal malformations associated spinal cord anomalies

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