Spina bifida occulta: Not to be overlooked in children with nocturnal enuresis

Abstract

Abbreviations & AcronymsObjective: Previous reports have suggested that the incidence of spina bifida occulta in patients with nocturnal enuresis is higher than in the general population. However, the effect of spina bifida occulta on the response to nocturnal enuresis treatment is controversial. The purpose of this study was to investigate the relationship between spina bifida occulta and response to treatment of nocturnal enuresis. Methods: Between 2006 and 2009, the records of 160 children with nocturnal enuresis were reviewed. Children with other organic urological disease or symptoms suggestive of spinal dysraphism were excluded. Plain radiography for the kidney-ureterbladder was carried out before the start of the nocturnal enuresis treatment. Response to treatment of children with and without spina bifida occulta was compared. Results: Of 160 children, 53 were girls; the mean age was 7.8 Ϯ 2.06 years. The mean duration of treatment was 8.7 Ϯ 9.29 months. Spina bifida occulta was detected in 43 children (26.9%). Spina bifida occulta affected L4 in four children, L5 in 12 children, S1 in 26 children and S2 in one child. There was a significant difference between the spina bifida occulta and non-spina bifida occulta groups in terms of outcome (P = 0.002), with a complete response more likely in children without spina bifida occulta (P = 0.005). None of the children with primary non-mono symptomatic nocturnal enuresis and spina bifida occulta showed a complete response. Conclusions:The presence of spina bifida occulta significantly affects the response to treatment in patients with nocturnal enuresis. Thus, verifying spina bifida occulta in this patient population can facilitate the prediction of the response to nocturnal enuresis treatment.

Ultrasonographic clues for diagnosis of spina bifida occulta in children

“…In summary, there is still considerable controversy on the significance of radiographic SBO in patients with lower urinary tract dysfunction. The incidence of SBO in the general population is reported as 1−22%, and the incidence of SBO is supposed to be higher in those with incontinence, voiding dysfunction or lower urinary tract abnormality than in the general population (3,8). A significantly higher incidence of SBO had been reported in a patient group suffering from voiding-related symptoms (4,7,8).…”

“…The incidence of SBO in the general population is reported as 1−22%, and the incidence of SBO is supposed to be higher in those with incontinence, voiding dysfunction or lower urinary tract abnormality than in the general population (3,8). A significantly higher incidence of SBO had been reported in a patient group suffering from voiding-related symptoms (4,7,8). Gallaway et al reported that 43% of patients with urinary incontinence also had deformities of vertebral arch (9).…”

“…SBO has been implicated as a marker for incomplete neurogenesis in the spinal cord (4,8). This theory relies on the assumption that SBO, as a pre-tethered cord, can affect the nerve cells of the lumbar and sacral region (4,7).…”

“…Although SBO occurs in the lower lumbar spines, it can be a marker of these abnormalities (5,6). In recent literature, SBO has been shown not to associated with any detectable structural spinal cord abnormalities through imaging modalities including MRI (3,7,8).…”

Chiropractic Care of Acute Low Back Pain and Incidental Spina Bifida Occulta: A Case Report

“…6,7 It usually is www.journalchiromed.com present at the levels of the 5th lumbar and 1st sacral vertebra. 6,8,9 Spina bifida occulta in most cases is asymptomatic, but symptoms among the population may include back pain, enuresis, motor or sensory dysfunction, and posterior disc herniation. 7,9,10 Fusion of vertebral lamina forms the spinous process, and this process serves as attachment sites for many extensor muscles.…”