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Vaja H, Kapoor A, Kaur G, Patwa J, Shah J. Split Cord Malformation Presentation and Management in Pediatric and Adult Cases: a Case Series. Childs Nerv Syst 2024:10.1007/s00381-024-06547-w. [PMID: 39037454 DOI: 10.1007/s00381-024-06547-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
The primary purpose of this study was to enhance the understanding of diastematomyelia, with a particular focus on adult-onset cases, which are infrequent and not fully elucidated. Additionally, the study sought to analyse the clinical features, diagnostic characteristics, and surgical interventions employed to manage the condition. This retrospective case series aimed to investigate diastematomyelia, a rare congenital deformation affecting the spinal cord. The study included 16 patients diagnosed with diastematomyelia, consisting of 13 pediatric cases (mean age: 7.6 years, age range: 5 months to 13 years) and 3 adult cases (mean age: 36 years, age range: 26 to 48 years). Among the paediatric cases, 9 were females, and 4 were males, while the adult cohort comprised 2 males and 1 female. The study design involved a thorough review of medical records, imaging reports, and surgical outcomes without specific inclusion or exclusion criteria. Surgical intervention emerged as the primary treatment modality for all cases, except one. Following surgical intervention, significant improvements were observed in pain management, motor function, and bladder control. Furthermore, additional findings indicated the presence of Dural Ectasia and Vertebral segmentation defects among the study population. This retrospective case series sheds light on the clinical features and surgical outcomes of diastematomyelia in both pediatric and adult patients. The findings underscore the importance of surgical intervention in alleviating symptoms and enhancing motor coordination and bladder control.
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Affiliation(s)
- HariOm Vaja
- Undergraduate Medical Student, Byramjee Jeejeebhoy Medical College & Civil Hospital, Ahmedabad, Gujarat, India.
| | - Abhay Kapoor
- Undergraduate Medical Student, Byramjee Jeejeebhoy Medical College & Civil Hospital, Ahmedabad, Gujarat, India
| | - Gurleen Kaur
- Undergraduate Medical Student, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Jividha Patwa
- Undergraduate Medical Student, Byramjee Jeejeebhoy Medical College & Civil Hospital, Ahmedabad, Gujarat, India
| | - Jaimin Shah
- Head of the Department Neurosurgery, Byramjee Jeejeebhoy Medical College & Civil Hospital, Ahmedabad, Gujarat, India
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Kerensky MJ, Paul A, Routkevitch D, Hersh AM, Kempski Leadingham KM, Davidar AD, Judy BF, Punnoose J, Williams A, Kumar A, Lehner K, Smith B, Son JK, Azadi JR, Shekhar H, Mercado-Shekhar KP, Thakor NV, Theodore N, Manbachi A. Tethered spinal cord tension assessed via ultrasound elastography in computational and intraoperative human studies. COMMUNICATIONS MEDICINE 2024; 4:4. [PMID: 38182729 PMCID: PMC10770351 DOI: 10.1038/s43856-023-00430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Tension in the spinal cord is a trademark of tethered cord syndrome. Unfortunately, existing tests cannot quantify tension across the bulk of the cord, making the diagnostic evaluation of stretch ambiguous. A potential non-destructive metric for spinal cord tension is ultrasound-derived shear wave velocity (SWV). The velocity is sensitive to tissue elasticity and boundary conditions including strain. We use the term Ultrasound Tensography to describe the acoustic evaluation of tension with SWV. METHODS Our solution Tethered cord Assessment with Ultrasound Tensography (TAUT) was utilized in three sub-studies: finite element simulations, a cadaveric benchtop validation, and a neurosurgical case series. The simulation computed SWV for given tensile forces. The cadaveric model with induced tension validated the SWV-tension relationship. Lastly, SWV was measured intraoperatively in patients diagnosed with tethered cords who underwent treatment (spinal column shortening). The surgery alleviates tension by decreasing the vertebral column length. RESULTS Here we observe a strong linear relationship between tension and squared SWV across the preclinical sub-studies. Higher tension induces faster shear waves in the simulation (R2 = 0.984) and cadaveric (R2 = 0.951) models. The SWV decreases in all neurosurgical procedures (p < 0.001). Moreover, TAUT has a c-statistic of 0.962 (0.92-1.00), detecting all tethered cords. CONCLUSIONS This study presents a physical, clinical metric of spinal cord tension. Strong agreement among computational, cadaveric, and clinical studies demonstrates the utility of ultrasound-induced SWV for quantitative intraoperative feedback. This technology is positioned to enhance tethered cord diagnosis, treatment, and postoperative monitoring as it differentiates stretched from healthy cords.
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Affiliation(s)
- Max J Kerensky
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abhijit Paul
- Discipline of Biological Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Denis Routkevitch
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew M Hersh
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelley M Kempski Leadingham
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Daniel Davidar
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joshua Punnoose
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Autumn Williams
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avisha Kumar
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kurt Lehner
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Beth Smith
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer K Son
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javad R Azadi
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Himanshu Shekhar
- Discipline of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Karla P Mercado-Shekhar
- Discipline of Biological Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amir Manbachi
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA.
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Tanimoto R, Ikuse T, Ito N, Sato H, Kasai Y, Yamada H, Saito N, Iwasaki T, Ikeno M, Suganuma H, Hisata K, Shoji H, Kudo T, Sakamoto K, Shimoji K, Kondo A, Shimizu T. A Case of Neonate with Split Cord Malformation Presenting with Hypoplasia of the Left Lower Extremity. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040726. [PMID: 37109684 PMCID: PMC10144382 DOI: 10.3390/medicina59040726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
The frequency of split cord malformation (SCM) is approximately 1 in 5000 births; however, patients are rarely diagnosed with SCM in the neonatal period. Moreover, there have been no reports of SCM with hypoplasia of the lower extremities at birth. A 3-day-old girl was transferred to our hospital for a thorough examination of hypoplasia of the left lower extremity and lumbosacral abnormalities detected after birth. The spinal magnetic resonance imaging (MRI) revealed a split spinal cord in a single dural tube. Based on the MRI findings, the patient was diagnosed with SCM type II. Following discussions with the parents, pediatricians, neurosurgeons, psychologists, and social workers, we decided to perform untethering to prevent further neurological impairment after achieving a sufficient body weight. The patient was discharged on day 25 of life. Early diagnosis and intervention may improve the neurological prognosis in terms of motor function, bladder and bowel function, and superficial sensation; thus, clinicians should report infrequent findings that may lead to SCM diagnosis. SCM should be differentiated in patients with left-right differences in the appearance of the lower extremity, particularly in those with lumbosacral abnormalities.
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Affiliation(s)
- Ryosuke Tanimoto
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Tamaki Ikuse
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Natsuki Ito
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Hiroyuki Sato
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Yuriha Kasai
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Hiromichi Yamada
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Nobutomo Saito
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Tomohiro Iwasaki
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Mitsuru Ikeno
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Hiroki Suganuma
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Ken Hisata
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Hiromichi Shoji
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Koichiro Sakamoto
- Department of Neurosurgery, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan
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Shin HI, Wang KC, Lee JY, Kim KH, Shin HI. Electrodiagnostic findings of retethering in children with spinal dysraphism. Acta Neurochir (Wien) 2023; 165:915-925. [PMID: 36862215 DOI: 10.1007/s00701-023-05539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Retethering of the cord can occur after the initial untethering surgery. Typical neurological manifestations indicative of cord tethering are often difficult to determine in pediatric patients. Patients who had a primary untethering operation are likely to present with some degree of neurological deficits from a previous tethering event, and urodynamic studies (UDSs) and spine images are frequently abnormal. Therefore, more objective tools to detect retethering are needed. This study sought to delineate the characteristics of EDS of retethering, and therefore, could support the diagnosis of retethering. METHODS Among 692 subjects who had an untethering operation, data from 93 subjects who had been suspected of retethering clinically were retrospectively extracted. The subjects were divided into two groups, a retethered group, and a non-progression group, according to whether or not surgical interventions had been performed. Two consecutive EDSs, clinical findings, spine magnetic resonance imaging scans, and UDSs before the development of new tethering symptoms were reviewed and compared. RESULTS In the electromyography (EMG) study, the appearance of abnormal spontaneous activity (ASA) in new muscles was prominent in the retethered group (p < 0.01). The loss of ASA was more pronounced in the non-progression group (p < 0.01). Specificity and sensitivity of EMG for retethering were 80.4 and 56.5%, respectively. In the nerve conduction study, the two groups did not show differences. The size of fibrillation potential was not different between the groups. CONCLUSIONS To provide support for a clinician's decision on retethering, EDS could be an advantageous tool with high specificity when the results are compared to previous EDS results. Routine follow-up EDS post-operatively is recommended as a baseline for comparison at the time when retethering is clinically suspected.
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Affiliation(s)
- Hyun Iee Shin
- Department of Rehabilitation Medicine, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 102 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, Republic of Korea
| | - Kyu-Chang Wang
- Neuro-Oncology Clinic, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Kyounggi-do, 10408, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Anatomy and Cell Biology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno‑Gu, Seoul, 03080, Republic of Korea
| | - Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Tahir Z, Craven C. Gastrulation and Split Cord Malformation. Adv Tech Stand Neurosurg 2023; 47:1-23. [PMID: 37640870 DOI: 10.1007/978-3-031-34981-2_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Split cord malformation (SCM) is a rare form of closed spinal dysraphism, in which two hemi-cords are present, instead of a single spinal cord. SCM is categorised into type 1 and type 2. Type 1 SCM is defined by the presence of a bony or osseocartilaginous spur between the hemi-cords, whereas type 2 SCM has no bony spur, and the two hemi-cords are contained within a single dura. In this chapter, we present the putative mechanisms by which SCM arises, including gastrulation defects and Pang's unified theory. The typical and rare clinical presentations and variations are described. Finally, we outline the step-by-step surgical approach to both SCM 1 and 2 and the overall prognosis of both conditions.
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Affiliation(s)
- Zubair Tahir
- Great Ormond Street Children Hospital, London, UK.
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6
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Hazneci J, Bastacı F, Börekci A, Öztürk ÖÇ, İş M, Somay A, Ekşi MŞ, Çelikoğlu E. Split cord malformation concomitant with spinal teratoma without open spinal dysraphism. Childs Nerv Syst 2022; 38:1977-1986. [PMID: 35687168 DOI: 10.1007/s00381-022-05578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Split cord malformation (SCM) presenting concomitant with spinal teratoma without any open spinal dysraphism has rarely been reported in the literature. We aimed to make a systematic review and qualitative analysis of the literature about the topic and present the first case of SCM concomitant with spinal teratoma harboring papillary thyroid carcinoma (PTC) component. METHODS Two big search tools (Pubmed/MEDLINE) and Scopus were used. The search strategy was compatible to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An exemplary case of ours was also presented. RESULTS There were 30 patients (15 pediatric and 15 adult). Female and male distribution was even. Median age of the patients was 18 years (range = 0-66 years). The most common presenting symptoms were back pain and lower limb weakness. Spinal teratoma and SCM mostly presented at thoracic/thoracolumbar region in children and lumbar region in adults. Surgical outcome was better in the children compared to the adults. CONCLUSION Thoracolumbar region is the most common location for such entity in children, whereas lumbar region for the adults. Surgical resection should be done as much as possible under neuromonitorization. The resected material should be evaluated thoroughly not to miss any malign pathology. Surgical outcome is better when it is done at an early age.
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Affiliation(s)
- Jülide Hazneci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Feryal Bastacı
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Ali Börekci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | | | - Merih İş
- Private Practice, Neurosurgery, Istanbul, Turkey
| | - Adnan Somay
- FSM Training and Research Hospital, Pathology Clinic, Istanbul, Turkey
| | - Murat Şakir Ekşi
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
- School of Medicine, Neurosurgery Research Laboratory, Yeditepe University, Istanbul, Turkey.
- , Istanbul, Turkey.
| | - Erhan Çelikoğlu
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
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Uy MNAR, Tantengco OAG. Investigating the landscape and trajectory of spina bifida research in Asia: a bibliometric analysis. Childs Nerv Syst 2022; 38:1581-1591. [PMID: 35474541 DOI: 10.1007/s00381-022-05527-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spina bifida is a type of a neural tube defect which affects 243.14 per 100,000 babies in Asia. Research articles on spina bifida have increased in the recent years. However, no study has focused on the research trends in this field in Asia. METHODS A systematic review of literature on spina bifida in Asia was performed using the Scopus database from inception to 2020. All published studies on spina bifida conducted in or published by authors from Asia were included in our analysis. Bibliometric information was obtained from Scopus and bibliometrics diagrams were created using VOSviewer software. RESULTS A total of 652 articles were obtained in this study. The number of publications showed an upward trend starting 2000s. The country with the greatest number of publications was Japan while All India Institute of Medical Sciences was the most productive institution in spina bifida research in Asia. The current focus of this field in Asia was prevalence of spina bifida, prenatal diagnosis, folic acid supplementation, and complications of spina bifida. Future areas of research in spina bifida include the genetic basis of neural tube defects and the use of stem cell technology as therapies for spina bifida. CONCLUSION This is the first bibliometric analysis on spina bifida in Asia. It showed the trend and future areas of research on spina bifida in Asia. Despite the increase in scientific literature on spina bifida research, more research outputs and collaborations are needed especially in developing countries in Asia.
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Affiliation(s)
| | - Ourlad Alzeus G Tantengco
- College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Philippines.
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Sacral Spina Bifida Occulta: A Frequency Analysis of Secular Change. ANTHROPOLOGICAL REVIEW 2022. [DOI: 10.18778/1898-6773.85.2.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Substantial relaxation of natural selection beginning around 1900 changed the mutation/selection balance of modern genetic material, producing an increase in variable anatomical structures. While multiple structures have been affected, the temporal increase in variations of the sacrum, specifically, ‘Sacral Spina Bifida Occulta,’ have been reliably demonstrated on a localised scale. Calculation of largescale frequency has been hindered by the localised nature of these publications, the morphological variability of this variation, and potential pathological associations, which have produced divergent classifications, and conflicting reported rates of occurrence. A systematic review of the reported literature was conducted to provide an objective analysis of Sacral Spina Bifida Occulta frequency from 2500 BCE to the present. This review was designed to compensate for observed inconsistencies in reporting and to ascertain, for the first time, the temporal trajectory of this secular trend. A systematic review of Sacral Spina Bifida Occulta literature was conducted through the strict use of clinical meta-analysis criteria. Publications were retrieved from four databases: PubMed, Embase, the Adelaide University Library database, and Google Scholar. Data were separated into three historical groups, (1 = <1900, 2 = 1900 to 1980 and 3 = >1980), and frequency outcomes compared, to determine temporal rates of occurrence.
A total of 39/409 publications were included in the final analysis, representing data for 16,167 sacra, spanning a period of 4,500 years. Statistically significant results were obtained, with total open S1 frequency increasing from 2.34%, (79 to 1900CE), to 4.80%, (1900 to 1980CE) and to 5.43% (>1980CE). These increases were significant at p<0.0001, with Chi-squared analysis. A clear secular increase in the global frequency of Sacral Spina Bifida Occulta has been demonstrated from 1900 to the present. This research provides a novel and adaptable framework for the future assessment of variation distribution, with important implications for the fields of biological anthropology and bioarchaeology.
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Xu K, He J, Wang L. A systematic review and meta-analysis of minimally invasive surgery in children with occult tethered cord syndrome. Transl Pediatr 2022; 11:403-410. [PMID: 35378968 PMCID: PMC8976679 DOI: 10.21037/tp-22-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND At present, the surgical treatment of occult tethered cord syndrome (OTCS) in children is mostly two types of minimally invasive surgery: filum terminalis laxity or filum terminalectomy. The clinical efficacy and safety of minimally invasive treatment and conservative treatment are still unclear. Therefore, this study will use the advantages of systematic review and meta-analysis to evaluate the objectivity, and explore the effect of minimally invasive surgery on children with occult tethered cord syndrome. METHODS A computer search was used to search PubMed, Embase, CNKI, Wanfang Database and other literature search websites about the randomized controlled trials (RCTs) of minimally invasive surgery in children with occult tethered cord syndrome and spinal lipoma. Professional journals were manually searched to avoid omissions. The search keywords were: occult myelolipoma, occult tethered cord syndrome, surgical treatment of tethered cord syndrome, occult tethered cord syndrome. RESULTS A total of 6 relevant literatures that could be used for meta-analysis were selected. A total of 425 subjects were included in the article, of which 132 were treated conservatively and 293 were treated surgically. The heterogeneity detection test statistics of the included studies were Chi2 (Chi-squared test) =8.18, df (degree of freedom) =5, I2=39%<50%, Z=2.53, and the homogeneity of the included studies was good. The number of unimproved cases under conservative treatment was 40, accounting for 30.30%; the number of unimproved cases under surgical treatment was 33, accounting for 11.26%, and the total unimproved rate of the two groups accounted for 17.17%. The unimproved rate of the experimental group was significantly lower than that of the control group, and the difference was statistically significant (P=0.01). The results of bias analysis showed that there was no significant bias in the literature included in this study. DISCUSSION Meta-analysis results confirmed that minimally invasive surgery has a significant effect on the treatment of occult children with tethered cord syndrome. However, due to the small sample size of the included literature, further evaluation of the treatment risk is required.
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Affiliation(s)
- Ketao Xu
- Pediatric Surgery, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Jianhua He
- Pediatric Surgery, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Leibo Wang
- Pediatric Surgery, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
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10
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Visser HJ, Wolfe J, Kouri R, Aviles R. Neurologic Conditions Associated with Cavus Foot Deformity. Clin Podiatr Med Surg 2021; 38:323-342. [PMID: 34053647 DOI: 10.1016/j.cpm.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The cavus foot deformity is an often less understood deformity within the spectrum of foot and ankle conditions. The hallmark concern is the possibility of an underlying neurologic or neuromuscular disorder. Although a proportion of these deformities are idiopathic, a significant majority do correlate with an underlying disorder. The appropriate evaluation of this deformity, in coordination within the multidisciplinary scope of health care, allows for a timely diagnosis and understanding of the patient's condition. We provide an abbreviated survey of possible underlying etiologies for the patient with the cavus foot deformity as a reference to the foot and ankle surgeon.
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Affiliation(s)
- Harry John Visser
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite 701, St Louis, MO 63044, USA
| | - Joshua Wolfe
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite 701, St Louis, MO 63044, USA.
| | - Rekha Kouri
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite 701, St Louis, MO 63044, USA
| | - Raul Aviles
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite 701, St Louis, MO 63044, USA
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Spellicy SE, Kilianski JR, Poston R, Moore-Hill D, Vale FL. Tethered brain: disentangling unintentional brain-mesh interfaces. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE21183. [PMID: 35855100 PMCID: PMC9245840 DOI: 10.3171/case21183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Surgical meshes have found widespread use in neurosurgical practice. While commonly recognized risks of synthetic mesh include infection, exposure of mesh implants, and foreign body reaction, the risk of mesh tethering to neural structures is often overlooked.
OBSERVATIONS
The authors presented the first case, to their knowledge, of the disentanglement of mesh interfaced to cortical tissue. The patient, a 68-year-old woman, presented with severe intractable seizure disorder and worsening left hand function and incoordination after meningioma resection and cranioplasty 9 years earlier. Magnetic resonance imaging (MRI) demonstrated interval progression of macrocystic encephalomalacia involving the right supplementary motor area, with fluid-attenuated inversion recovery signal extending posteriorly into the right primary motor cortex. Both computed tomography and MRI suggested potential tethering of the cortex to the overlying cranioplasty mesh. Because of the progressive nature of her condition, the decision was made to surgically remove the tethered mesh.
LESSONS
De-tethering brain parenchyma from surgical mesh requires careful microdissection and judicious use of electrocautery to minimize further tissue damage and preserve neurological function. This inadvertent complication evinces the importance of using dural substitutes when unable to primarily repair the dura to prevent scarring and tethering of neural tissues to synthetic cranioplasty materials.
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12
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McElroy A, Klinge PM, Sledge D, Donahue JE, Glabman RA, Rashmir A. Evaluation of the Filum Terminale in Hereditary Equine Regional Dermal Asthenia. Vet Pathol 2021; 58:1100-1106. [PMID: 34056982 DOI: 10.1177/03009858211018660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objectives of this study were to describe the anatomy, histology, and ultrastructure of the equine filum terminale (FT) and to describe the FT in hereditary equine regional dermal asthenia (HERDA), a model of human Ehlers-Danlos syndromes (EDS). Those humans suffer from tethered cord syndrome (TCS) caused by an abnormally structured FT wherein its attachment at the base of the vertebral column leads to long-term stretch-induced injury to the spinal cord. The pathophysiology of TCS in EDS is poorly understood, and there is a need for an animal model of the condition. Histopathologic and ultrastructural examinations were performed on FT from HERDA (n = 4) and control horses (n = 5) and were compared to FT from human TCS patients with and without EDS. Adipose, fibrous tissue, and neuronal elements were assessed. CD3 and CD20 immunohistochemistry was performed to clarify cell types (HERDA n = 2; control n = 5). Collagen fibrils were assessed in cross-section for fibril diameter and shape, and in longitudinal section for fibril disorganization, swelling, and fragmentation. The equine and human FT were similar, with both containing fibrous tissue, ependyma, neuropil, and nerve twigs. Hypervascularity was observed in both HERDA horses and human EDS-TCS patients and was not observed in equine or human controls. Moderate to severe abnormalities in collagen fibril orientation and architecture were observed in all HERDA horses and were similar to those observed in human EDS-TCS patients.
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Affiliation(s)
- Abigail McElroy
- 23325Rhode Island Hospital, Providence, RI, USA.,Brown University, Providence, RI, USA
| | - Petra M Klinge
- 23325Rhode Island Hospital, Providence, RI, USA.,Brown University, Providence, RI, USA
| | - Dodd Sledge
- 116098Michigan State University, East Lansing, MI, USA
| | - John E Donahue
- 23325Rhode Island Hospital, Providence, RI, USA.,Brown University, Providence, RI, USA
| | - Raisa A Glabman
- 116098Michigan State University, East Lansing, MI, USA.,Dr Glabman is now with the National Institutes of Health, Bethesda, MD, USA
| | - Ann Rashmir
- 116098Michigan State University, East Lansing, MI, USA.,Dr Rashmir is now with the Veterinary Surgical Services, Washington, DC, USA
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Mishra A, Nadeem M, Prabhuraj AR, Paul P, Bhat D. Tetrad of Split Cord Malformation I with Neuroenteric Cyst, Dermoid Cyst, and Thickened Filum Terminale in a 2-Year-Old Child: A Case Report. Pediatr Neurosurg 2021; 56:448-454. [PMID: 34293742 DOI: 10.1159/000514534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Split cord malformations (SCMs) are developmental anomalies that are associated with a number of congenital defects. However, a combination of SCM I with a neuroenteric cyst (NEC) is extremely rare, and only 11 cases have been described in the literature. To the best of authors' knowledge, the combination of the above two with dermoid cyst and thickened filum terminale has never been reported in the literature. CASE PRESENTATION We present a case of the above combination in a 2-year-old child who underwent microsurgical excision of all 4 pathologies and complete recovery. CONCLUSION NEC and dermoid should be considered in the differential diagnosis when imaging reveals cystic pathology along with SCM. Expeditious surgical repair resulted in an outstanding functional outcome at 1-year follow-up.
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Affiliation(s)
- Ajit Mishra
- Neurosurgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Mohammed Nadeem
- Department of Neurosurgery, National Institute of Mental health and Neurosciences, Bengaluru, India
| | | | - Paramita Paul
- Department of Neuropathology, National Institute of Mental health and Neurosciences, Bengaluru, India
| | - Dhananjaya Bhat
- Department of Neurosurgery, National Institute of Mental health and Neurosciences, Bengaluru, India
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14
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Sun Y, Ning G, Li X, Qu H, Zeng J. MRI characteristics of the fetal tethered spinal cord: a comparative study. Int J Neurosci 2020; 132:975-984. [PMID: 33272085 DOI: 10.1080/00207454.2020.1858829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To compare fetuses and children with confirmed tethered cord syndrome to age-matched controls to provide a reference for prenatally identifying tethered spinal cord and to identify salient points on MRI for diagnosis.Materials and Methods: This retrospective study enrolled 13 fetuses and 20 children with tethered cord syndrome, and age-matched counterparts were included as controls. The MRI features including concomitant malformations, position of the conus medullaris, and thickened filum terminale of the two patient groups were evaluated and compared. Levels of the conus medullaris were discriminated between patients and an equivalent number of controls.Results: Various concomitant malformations manifested on the MRI of all patients, and there were differences between the two patient groups. Significant differences of the level of the conus medullaris were found between the fetal and child patients (U, 26.50; Z, -3.87; p < 0.001) and between the normal fetus and child controls (U, 23.50; Z, -4.13; p < 0.001). The position of the conus medullaris was visibly lower in the patient groups than in the control groups. No significant difference in the diameters of the filum terminale was found between the fetal and child patients (p = 0.67).Conclusions: The current study's results indicate that tethered spinal cord syndrome can be diagnosed in utero with MRI combined with several characteristics, particularly the position of the conus medullaris. Special attention should be paid to the gestational age of the fetus because normal changes in spinal cord position occur with gestational development.
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Affiliation(s)
- Yan Sun
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Gang Ning
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Xuesheng Li
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Haibo Qu
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Jiangang Zeng
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
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15
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Royo-Salvador MB, Fiallos-Rivera MV, Salca HC, Ollé-Fortuny G. The Filum disease and the Neuro-Cranio-vertebral syndrome: definition, clinical picture and imaging features. BMC Neurol 2020; 20:175. [PMID: 32393196 PMCID: PMC7212596 DOI: 10.1186/s12883-020-01743-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/22/2020] [Indexed: 11/21/2022] Open
Abstract
Background We propose two new concepts, the Filum Disease (FD) and the Neuro-cranio-vertebral syndrome (NCVS), that group together conditions thus far considered idiopathic, such as Arnold-Chiari Syndrome Type I (ACSI), Idiopathic Syringomyelia (ISM), Idiopathic Scoliosis (IS), Basilar Impression (BI), Platybasia (PTB) Retroflexed Odontoid (RO) and Brainstem Kinking (BSK). Method We describe the symptomatology, the clinical course and the neurological signs of the new nosological entities as well as the changes visible on imaging studies in a series of 373 patients. Results Our series included 72% women with a mean age of 33.66 years; 48% of the patients had an interval from onset to diagnosis longer than 10 years and 64% had a progressive clinical course. The commonest symptoms were: headache 84%, lumbosacral pain 72%, cervical pain 72%, balance alteration 72% and paresthesias 70%. The commonest neurological signs were: altered deep tendon reflexes in upper extremities 86%, altered deep tendon reflexes in lower extremities 82%, altered plantar reflexes 73%, decreased grip strength 70%, altered sensibility to temperature 69%, altered abdominal reflexes 68%, positive Mingazzini’s test 66%, altered sensibility to touch 65% and deviation of the uvula and/or tongue 64%. The imaging features most often seen were: altered position of cerebellar tonsils 93%, low-lying Conus medullaris below the T12L1 disc 88%, idiopathic scoliosis 76%, multiple disc disease 72% and syringomyelic cavities 52%. Conclusions This is a paradigm shift that opens up new paths for research and broadens the range of therapeutics available to these patients.
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Affiliation(s)
- Miguel B Royo-Salvador
- Institut Chiari & Siringomielia & Escoliosis de Barcelona, Passeig Manuel Girona 16, 08034, Barcelona, Spain.
| | - Marco V Fiallos-Rivera
- Institut Chiari & Siringomielia & Escoliosis de Barcelona, Passeig Manuel Girona 16, 08034, Barcelona, Spain
| | - Horia C Salca
- Institut Chiari & Siringomielia & Escoliosis de Barcelona, Passeig Manuel Girona 16, 08034, Barcelona, Spain
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16
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Hode L, Noukpozounkou SB, Avakoudjo JDG, Alihonou T, Assan BR, Gbenou SA, Fiogbe MA. [Tethered cord syndrome in children: about a case]. Pan Afr Med J 2020; 34:151. [PMID: 32110267 PMCID: PMC7024106 DOI: 10.11604/pamj.2019.34.151.18344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 06/19/2019] [Indexed: 12/03/2022] Open
Abstract
Le syndrome de la moelle attachée est un ensemble de symptômes neurologiques dû à une traction axiale constante ou intermittente du cône terminal de la moelle spinale, fixé en position caudale anormale. Il s'agit d'une lésion congénitale rare dont les symptômes peuvent s'exprimer qu'à l'âge adulte. Nous rapportons un cas clinique chez un garçon de 10 ans découvert à la suite d'une incontinence vésicale et anale qui a été confirmé par une imagerie par résonnance magnétique lombo-sacrée. Il a bénéficié d'une libération neurochirurgicale du cône terminal par un abord postérieur. L'évolution a été marquée par une amélioration des troubles sphinctériens. Ce cas est suivi d'une revue de littérature sur le sujet. Ce cas met l'accent sur l'intérêt de l’imagerie par résonance magnétique (IRM) dans le diagnostic de cette affection.
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Affiliation(s)
- Luphin Hode
- Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, Cotonou, Bénin
| | | | | | - Thierry Alihonou
- Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, Cotonou, Bénin
| | | | | | - Michel Armand Fiogbe
- Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, Cotonou, Bénin
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17
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Bradko V, Castillo H, Janardhan S, Dahl B, Gandy K, Castillo J. Towards Guideline-Based Management of Tethered Cord Syndrome in Spina Bifida: A Global Health Paradigm Shift in the Era of Prenatal Surgery. Neurospine 2019; 16:715-727. [PMID: 31284336 PMCID: PMC6944994 DOI: 10.14245/ns.1836342.171] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/08/2019] [Accepted: 06/01/2019] [Indexed: 01/04/2023] Open
Abstract
An estimated 60% of the world's population lives in Asia, where the incidence of neural tube defects is high. Aware that tethered cord syndrome (TCS) is an important comorbidity, the purpose of this systematic review was to explore the treatment of TCS among individuals living with spina bifida (SB) in Asia. MEDLINE and Embase databases were searched for relevant studies published from January 2000 to June 2018. Search terms such as 'spinal dysraphism,' 'spinabifida,' 'diastematomyelia,' 'lipomeningocele,' 'lypomyelomeningocele,' 'meningomyelocele,' and 'tethered cord syndrome' were used in diverse combinations. Of the 1,290 articles that were identified in accordance with PRISMA (Preferred Items for Systematic Reviews and Meta-Analyses) guidelines, 15 Asia-based studies met the inclusion criteria. Significant differences in the diagnostic criteria and management of TCS were documented. As the surgical techniques for prenatal closure of the spinal defect continue to evolve, their adoption internationally is likely to continue. In this setting, a clear and evidence-based approach to the definition and management of TCS is essential. The recent publication by the Spina Bifida Association of America of their updated care guidelines may serve as a tool used to promote a systematized approach to diagnosing and treating TCS among individuals with SB in the region, as well as globally.
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Affiliation(s)
- Viachaslau Bradko
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Orthopedic and Scoliosis Surgery, Texas Children’s Hospital, Houston, TX, USA
| | - Heidi Castillo
- Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Shruthi Janardhan
- Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Benny Dahl
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Orthopedic and Scoliosis Surgery, Texas Children’s Hospital, Houston, TX, USA
| | - Kellen Gandy
- Department of Pediatrics, Staten Island University Hospital, Staten Island, NY, USA
| | - Jonathan Castillo
- Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
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18
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Bhimani AD, Selner AN, Patel JB, Hobbs JG, Esfahani DR, Behbahani M, Zayyad Z, Nikas D, Mehta AI. Pediatric tethered cord release: an epidemiological and postoperative complication analysis. JOURNAL OF SPINE SURGERY 2019; 5:337-350. [PMID: 31663045 DOI: 10.21037/jss.2019.09.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background Tethered cord release (TCR) is a common procedure in pediatric neurosurgery. Despite a reputation for being relatively safe, the risk factors for postoperative complications are poorly understood. Methods In this study, the American College of Surgeons-National Surgical Quality Improvement Program Pediatric Database (ACS-NSQIP-P) was reviewed to identify the demographics, risk factors, and 30-day postoperative complications for tethered cord release using univariate and multivariate analysis. A detailed analysis of reasons for readmission and reoperation was also performed. Results Three thousand and six hundred eighty-two pediatric patients were studied. Males undergoing TCR were younger (5.6 vs. 6.1 years) and had a higher rate of pre-operative comorbidities but lower 30-day complication rate versus females. Patients who later developed complications were more likely to require a microscope intraoperatively, had longer operative times, and worse preoperative American Society of Anesthesiologists (ASA) class. Conclusions Despite being a relatively safe procedure, TCR in the pediatric population carries a finite risk of complications. In this large, international database study, males were found to have a greater number of risk factors prior to TCR, while females exhibit a higher risk of developing postoperative complications. This paper provides a large sample size of multi institutional pediatric patients undergoing TCR and may serve as a contemporary "snapshot" for future studies.
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Affiliation(s)
- Abhiraj D Bhimani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashley N Selner
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Jay B Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Jonathan G Hobbs
- Section of Neurosurgery, The University of Chicago, Chicago, IL, USA
| | - Darian R Esfahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Zaid Zayyad
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Demetrios Nikas
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Incidence of Congenital Spinal Abnormalities Among Pediatric Patients and Their Association With Scoliosis and Systemic Anomalies. J Pediatr Orthop 2019; 39:e608-e613. [PMID: 31393300 DOI: 10.1097/bpo.0000000000001066] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Congenital abnormalities when present, according to VACTERL theory, occur nonrandomly with other congenital anomalies. This study estimates the prevalence of congenital spinal anomalies, and their concurrence with other systemic anomalies. METHODS A retrospective cohort analysis on Health care Cost and Utilization Project's Kids Inpatient Database (KID), years 2000, 2003, 2006, 2009 was performed. ICD-9 coding identified congenital anomalies of the spine and other body systems. OUTCOME MEASURES Overall incidence of congenital spinal abnormalities in pediatric patients, and the concurrence of spinal anomaly diagnoses with other organ system anomalies. Frequencies of congenital spine anomalies were estimated using KID hospital-and-year-adjusted weights. Poisson distribution in contingency tables tabulated concurrence of other congenital anomalies, grouped by body system. RESULTS Of 12,039,432 patients, rates per 100,000 cases were: 9.1 hemivertebra, 4.3 Klippel-Fiel, 56.3 Chiari malformation, 52.6 tethered cord, 83.4 spina bifida, 1.2 absence of vertebra, and 6.2 diastematomyelia. Diastematomyelia had the highest concurrence of other anomalies: 70.1% of diastematomyelia patients had at least one other congenital anomaly. Next, 63.2% of hemivertebra, and 35.2% of Klippel-Fiel patients had concurrent anomalies. Of the other systems deformities cooccuring, cardiac system had the highest concurrent incidence (6.5% overall). In light of VACTERL's definition of a patient being diagnosed with at least 3 VACTERL anomalies, hemivertebra patients had the highest cooccurrence of ≥3 anomalies (31.3%). With detailed analysis of hemivertebra patients, secundum ASD (14.49%), atresia of large intestine (10.2%), renal agenesis (7.43%) frequently cooccured. CONCLUSIONS Congenital abnormalities of the spine are associated with serious systemic anomalies that may have delayed presentations. These patients continue to be at a very high, and maybe higher than previously thought, risk for comorbidities that can cause devastating perioperative complications if not detected preoperatively, and full MRI workups should be considered in all patients with spinal abnormalities. LEVEL OF EVIDENCE Level III.
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20
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Jahangiri FR, Sayegh SA, Azzubi M, Alrajhi AM, Annaim MM, Al Sharif SA, Aziz T, Al Eissa S. Benefit of Intraoperative Neurophysiological Monitoring in a Pediatric Patient with Spinal Dysmorphism, Split Cord Malformation, and Scoliosis. Neurodiagn J 2017; 57:295-307. [PMID: 29236600 DOI: 10.1080/21646821.2017.1396780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Intraoperative neurophysiological monitoring (IONM) consists of a group of neurodiagnostic techniques that assess the nervous system's functional integrity during surgical operations. A retrospective analysis of a pediatric female patient was conducted who underwent 12 operations for the correction of scoliosis, tethered cord, and split spinal cord wherein IONM played an important role. From age 3 to 6, she underwent six procedures including a release of the tethered cord, resection of the filum terminale, removal of a T11-T12 bony spur, release of L3 adhesions, repair of subcutaneous meningocele, and correction of scoliosis with a vertical expandable prosthetic titanium rod (VEPTR) technique without the use of IONM. However, a multimodality IONM protocol with somatosensory evoked potentials, transcranial electrical motor evoked potentials (TCeMEP), and an electromyogram was utilized during the later procedures. At age 6 (the seventh procedure), a VEPTR expansion was performed, with loss and recovery of the lower extremity motor evoked potentials. The postoperative magnetic resonance imaging (MRI) showed a partial split cord malformation with retethering of the spinal cord. We repaired her split cord malformation and tethered cord while employing IONM. Using IONM for her operation was crucial because a sudden significant loss of TCeMEP resulted in a cancellation of the procedure; the MRI showed a thick remnant attached to the spinal cord. If the procedure was performed without IONM, we could have missed the underlying pathology, an error that may have resulted in paraplegia. We strongly recommend using IONM during high-risk surgical procedures to help significantly reduce the risk of permanent postoperative complications.
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Affiliation(s)
- Faisal R Jahangiri
- a Division of Neurology, Department of Medicine, King Abdulaziz Medical City , Ministry of National Guard Health Affairs , Riyadh , Saudi Arabia.,b Department of Neurosurgery , Neuroscience Institute, Hamad Medical Corporation , Doha , Qatar.,c Jahangiri Consulting LLC , Charlottesville , Virginia
| | - Samir Al Sayegh
- d Division of Orthopedics, Department of Surgery, King Abdulaziz Medical City , Ministry of National Guard Health Affairs , Riyadh , Saudi Arabia
| | - Moutasem Azzubi
- e Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City , Ministry of National Guard Health Affairs , Riyadh , Saudi Arabia
| | | | - Monerah M Annaim
- g College of Medicine-Female, KSAU-HS, King Abdulaziz Medical City , Ministry of National Guard Health Affairs , Riyadh , Saudi Arabia
| | - Shmoukh A Al Sharif
- g College of Medicine-Female, KSAU-HS, King Abdulaziz Medical City , Ministry of National Guard Health Affairs , Riyadh , Saudi Arabia
| | - Tanweer Aziz
- h Department of Anesthesia, King Abdulaziz Medical City , Ministry of National Guard Health Affairs , Riyadh , Saudi Arabia
| | - Sami Al Eissa
- d Division of Orthopedics, Department of Surgery, King Abdulaziz Medical City , Ministry of National Guard Health Affairs , Riyadh , Saudi Arabia
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Henderson FC, Austin C, Benzel E, Bolognese P, Ellenbogen R, Francomano CA, Ireton C, Klinge P, Koby M, Long D, Patel S, Singman EL, Voermans NC. Neurological and spinal manifestations of the Ehlers-Danlos syndromes. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:195-211. [PMID: 28220607 DOI: 10.1002/ajmg.c.31549] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Ehlers-Danlos syndromes (EDS) are a heterogeneous group of heritable connective tissue disorders characterized by joint hypermobility, skin extensibility, and tissue fragility. This communication briefly reports upon the neurological manifestations that arise including the weakness of the ligaments of the craniocervical junction and spine, early disc degeneration, and the weakness of the epineurium and perineurium surrounding peripheral nerves. Entrapment, deformation, and biophysical deformative stresses exerted upon the nervous system may alter gene expression, neuronal function and phenotypic expression. This report also discusses increased prevalence of migraine, idiopathic intracranial hypertension, Tarlov cysts, tethered cord syndrome, and dystonia, where associations with EDS have been anecdotally reported, but where epidemiological evidence is not yet available. Chiari Malformation Type I (CMI) has been reported to be a comorbid condition to EDS, and may be complicated by craniocervical instability or basilar invagination. Motor delay, headache, and quadriparesis have been attributed to ligamentous laxity and instability at the atlanto-occipital and atlantoaxial joints, which may complicate all forms of EDS. Discopathy and early degenerative spondylotic disease manifest by spinal segmental instability and kyphosis, rendering EDS patients prone to mechanical pain, and myelopathy. Musculoskeletal pain starts early, is chronic and debilitating, and the neuromuscular disease of EDS manifests symptomatically with weakness, myalgia, easy fatigability, limited walking, reduction of vibration sense, and mild impairment of mobility and daily activities. Consensus criteria and clinical practice guidelines, based upon stronger epidemiological and pathophysiological evidence, are needed to refine diagnosis and treatment of the various neurological and spinal manifestations of EDS. © 2017 Wiley Periodicals, Inc.
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22
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Sysoev KV, Tadevosyan AR, Nazinkina YV, Khachatryan VA. [Surgical treatment outcomes in children with tethered spinal cord syndrome. A prognosis on the basis of spinal 3T MRI tractography]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:66-73. [PMID: 27296539 DOI: 10.17116/neiro201680366-73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM The study objective was to identify factors affecting surgical treatment outcomes in children with tethered cord syndrome (TCS). MATERIAL AND METHODS The study included 21 TCS patients aged 1 to 14 years who underwent tethered cord release. The preoperative and postoperative data of clinical and neurophysiological examination and high field (3T) MRI tractography of the caudal spinal cord were compared. RESULTS Regression of the TCS clinical and electrophysiological signs and the lack of pathological changes in the spinal cord tracts were observed in patients with filum terminale abnormalities and caudal lipomas after surgery. In patients with secondary spinal cord tethering caused by scar formation after lumbosacral myelomeningocele repair, a motor deficit was related to the interruption level of the spinal tracts, and surgical treatment did not lead to significant regression of the TCS clinical and electrophysiological signs. CONCLUSION We consider the absence of pathological changes in the caudal spinal cord, based on spinal MRI tractography, as a favorable prognostic factor in TCS surgical treatment.
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Affiliation(s)
- K V Sysoev
- Polenov Russian Scientific Research Institute of Neurosurgery - the branch of Federal Almazov North-West Medical Research Centre, St.-Petersburg
| | - A R Tadevosyan
- Polenov Russian Scientific Research Institute of Neurosurgery - the branch of Federal Almazov North-West Medical Research Centre, St.-Petersburg
| | - Yu V Nazinkina
- Polenov Russian Scientific Research Institute of Neurosurgery - the branch of Federal Almazov North-West Medical Research Centre, St.-Petersburg
| | - V A Khachatryan
- Polenov Russian Scientific Research Institute of Neurosurgery - the branch of Federal Almazov North-West Medical Research Centre, St.-Petersburg
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23
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Nair LD, Sagayaraj B, V T T R, Kumar R. Incontinence in Intellectual Disability: An Under Recognized Cause. J Clin Diagn Res 2015; 9:SD01-2. [PMID: 26500975 DOI: 10.7860/jcdr/2015/14019.6448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/10/2015] [Indexed: 11/24/2022]
Abstract
Many children with Down syndrome may develop urinary incontinence during adolescence or nearing adulthood. Most often low mental ability, behavioural issues, urinary tract infection, hypothyroidism, atlanto-axial subluxation or sexual abuse may be suspected to be the reason. We report a case of Down syndrome with tethered cord syndrome (TCS) and Lipoma of Filum terminale with Cauda equina in normal position, as a cause of bowel and bladder incontinence. The need for operating with Cauda Equina in normal position is debated. But a conscious decision was taken to operate and the incontinence improved markedly which was documented by using a standardized questionnaire (King's questionnaire) and thereby making a difference in the child's life. A literature search did not result in any case of Down syndrome with tethered cord syndrome and secondary incontinence as presentation. Considering the possibility of TCS as a cause of incontinence, often neglected even in normal children, careful evaluation and correction of such problems will make a difference in the life of many intellectually disabled children. Incontinence should not be casually attributed to intellectual disability without ruling out other causes.
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Affiliation(s)
| | - Benjamin Sagayaraj
- Associate Professor, Department of Paediatrics, Saveetha Medical College , Thandalam, Chennai, India
| | - Rajan V T T
- Assistant Professor, Department of Neurosurgery, Saveetha Medical College , Thandalam, Chennai, India
| | - Radha Kumar
- Professor, Department of Paediatrics, Saveetha Medical College , Thandalam, Chennai, India
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Granada C, Loveless M, Justice T, Moriarty T, Mutchnick I, Dietrich JE, LaJoie AS, Hertweck P. Tethered Cord Syndrome in the Pediatric-Adolescent Gynecologic Patient. J Pediatr Adolesc Gynecol 2015; 28:309-12. [PMID: 26092705 DOI: 10.1016/j.jpag.2014.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/25/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To describe how pediatric and adolescent patients present to the gynecologist when they have tethered cord syndrome (TCS). DESIGN We conducted a retrospective chart review on all patients suspected by the gynecologist of having TCS. SETTING Single pediatric and adolescent gynecology clinic in a mid-sized city in the midwest. PARTICIPANTS Thirty-two patients, first seen between 2005 and 2012, suspected of having TCS and for whom follow-up information was available. INTERVENTIONS AND MAIN OUTCOME MEASURES Patient characteristics, including patient history, gynecologic clinical indicators, clinical outcomes, indications for surgery, and postoperative resolution of symptoms, were reviewed. RESULTS The initial review of systems indicated stress urinary incontinence, back pain, and constipation as common markers in the 32 patients who were suspected of having TCS. All 32 patients underwent lumbar magnetic resonance imaging without contrast and evaluation by neurosurgery. Of the 32 patients with suspected TCS, 18 were later confirmed and 14 were shown to not have TCS. Of the 18 patients with sufficient information to justify a detethering procedure, 14 patients were followed and 93% (13 patients) had complete resolution of symptoms. Final diagnosis in the non-TCS group varied, including vulvovaginitis, enuresis, chronic constipation, and lichen sclerosis. Symptoms improved with the treatment of each primary condition. CONCLUSIONS TCS symptoms overlap with gynecologic conditions; therefore, patients with TCS may present initially to the gynecologist. In pediatric/adolescent patients, TCS should be considered when stress urinary incontinence, back pain, and constipation are discovered in the review of systems. Because possible irreversible ischemic and neurologic changes are believed to be involved, early diagnosis and surgery are crucial for resolution. Providers should be aware of TCS in these pediatric and adolescent settings, because quick assessment may result in complete resolution of a chronic progressive disease.
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Affiliation(s)
- Catalina Granada
- Department of Obstetrics and Gynecology, Florida International University, Miami, Florida.
| | - Meredith Loveless
- Department of Obstetrics and Gynecology, Florida International University, Miami, Florida; Department of Obstetrics and Gynecology, University of Louisville, Louisville, Kentucky
| | - Tiffany Justice
- Department of Obstetrics and Gynecology, University of Louisville, Louisville, Kentucky
| | - Thomas Moriarty
- Kosair Children's Hospital, Pediatric Neurosurgery, Louisville, Kentucky
| | - Ian Mutchnick
- Kosair Children's Hospital, Pediatric Neurosurgery, Louisville, Kentucky
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - A Scott LaJoie
- Department of Health Promotion and Behavioral Sciences, University of Louisville, School of Public Health and Information Sciences, Louisville, Kentucky
| | - Paige Hertweck
- Department of Obstetrics and Gynecology, Florida International University, Miami, Florida; Department of Obstetrics and Gynecology, University of Louisville, Louisville, Kentucky
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Lo A, Polšek D, Sidhu S. Estimating the burden of neural tube defects in low- and middle-income countries. J Glob Health 2014; 4:010402. [PMID: 24976961 PMCID: PMC4073251 DOI: 10.7189/jogh.04.010402] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND To provide an estimate for the burden of neural tube defects (NTD) in low- and middle-income countries (LMIC) and explore potential public health policies that may be implemented. Although effective interventions are available to prevent NTD, there is still considerable childhood morbidity and mortality present in LMIC. METHODS A search of Medline, EMBASE, Global Health Library and PubMed identified 37 relevant studies that provided estimates of the burden of NTD in LMIC. Information on burden of total NTD and specific NTD types was separated according to the denominator into two groups: (i) estimates based on the number of live births only; and (ii) live births, stillbirths and terminations. The data was then extracted and analysed. RESULTS The search retrieved NTD burden from 18 countries in 6 WHO regions. The overall burden calculated using the median from studies based on livebirths was 1.67/1000 (IQR = 0.98-3.49) for total NTD burden, 1.13/1000 (IQR = 0.75-1.73) for spina bifida, 0.25/1000 (IQR = 0.08-1.07) for anencephaly and 0.15/1000 (IQR = 0.08-0.23) for encephalocele. Corresponding estimates based on all pregnancies resulting in live births, still births and terminations were 2.55/1000 (IQR = 1.56-3.91) for total NTD burden, 1.04/1000 (IQR = 0.67-2.48) for spina bifida, 1.03/1000 (IQR = 0.67-1.60) for anencephaly and 0.21 (IQR = 0.16-0.28) for encephalocele. This translates into about 190 000neonates who are born each year with NTD in LMIC. CONCLUSION Limited available data on NTD in LMIC indicates the need for additional research that would improve the estimated burden of NTD and recommend suitable aid policies through maternal education on folic acid supplementation or food fortification.
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Affiliation(s)
- Annie Lo
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Dora Polšek
- Histology and Embryology Department, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Simrita Sidhu
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
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Alzhrani GA, Al-Jehani HM, Melançon D. Multi-level Split Cord Malformation: Do We Need a New Classification? J Clin Imaging Sci 2014; 4:32. [PMID: 25161801 PMCID: PMC4142467 DOI: 10.4103/2156-7514.135181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/16/2014] [Indexed: 12/02/2022] Open
Abstract
Split cord malformations (SCMs) are thought to be rare abnormalities representing 3.8-5% of all spinal cord anomalies. The prevalence is estimated to be 1 in 5499 live births (0.02%), with a slight female predominance (1.3:1). Although the estimates of prevalence vary, Type I SCM occurs more frequently than Type II SCM. In this paper, we are reporting the clinical presentation and imaging findings of multi-level SCM in a 27-year-old male. A literature review of the embryological background of SCM and pathological hypothesis for this entity is provided. A systematic review has been conducted to identify multi-level SCM cases reported in the literature, followed by proposing a new classification system to further our understanding and management of SCMs.
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Affiliation(s)
- Gmaan A Alzhrani
- Department of Neurosurgery, Montreal Neurological Institution and Hospital, Montreal, Canada ; Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hosam M Al-Jehani
- Department of Neurosurgery, Montreal Neurological Institution and Hospital, Montreal, Canada ; Department of Neurosurgery, King Fahad University Hospital, Dammam University, Alkhobar, Saudi Arabia
| | - Denis Melançon
- Department of Neuroradiology, McGill University Health Centre, McGill University, Montreal, Canada
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Early identification of tethered cord syndrome: a clinical challenge. J Pediatr Health Care 2014; 28:e23-33. [PMID: 23932444 DOI: 10.1016/j.pedhc.2013.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 06/23/2013] [Accepted: 06/29/2013] [Indexed: 11/21/2022]
Abstract
Tethered cord syndrome (TCS) is a progressive clinical condition that arises from excessive spinal cord tension. The clinical signs and symptoms of TCS may be cutaneous, neurologic, musculoskeletal, genitourinary, and/or gastrointestinal. Patients also may be asymptomatic, which does not exclude the diagnosis of TCS. Although the exact etiology is unknown, early identification and lifelong surveillance or surgical treatment is an essential component of patient management. In this article we review the pathophysiology, various etiologies, clinical presentation, and long-term sequelae of TCS. This information will help pediatric nurse practitioners identify TCS early and anticipate the patient's needs and management requirements.
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Thompson EM, Strong MJ, Warren G, Woltjer RL, Selden NR. Clinical significance of imaging and histological characteristics of filum terminale in tethered cord syndrome. J Neurosurg Pediatr 2014; 13:255-9. [PMID: 24404969 DOI: 10.3171/2013.12.peds13370] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The pathophysiology of tethered cord syndrome (TCS) is uncertain; however, it has been suggested that fibrous and fatty elements within the filum terminale (FT) play a role. The objective of this study was to describe the radiological and histological features of the FT in TCS and determine if there are associations between those features and clinical outcomes, complications, and urodynamics. METHODS In this retrospective study, histological, MRI, and clinical data obtained in 293 patients with TCS who underwent FT transection were reviewed and analyzed in a multivariate analysis. RESULTS The median patient age was 4.9 years (range 0.3-64.3 years). On MRI, a fatty filum was present in 65% of patients and a thickened filum (> 2 mm) was seen in 45%. Histologically, the FT contained prominent fibrous tissue in 95%, nerve twigs in 79%, adipose tissue in 59%, and vascular tissue in 36%. Histological features associated with a thickened filum on MR images were adipose tissue (OR 3.5, p < 0.001), nerve twigs (OR 2.2, p = 0.028), and vascular tissue (OR 0.5, p = 0.025). Adipose tissue was associated with a conus level below the L2-3 disc space (OR 2.3, p = 0.031) and with a fatty filum on imaging (OR 9.8, p < 0.001). Nerve twigs were associated with abnormal urodynamics (OR 10.9, p = 0.049). The only variable predictive of clinical improvement was conus level; patients with conus levels caudal to L-2 were less likely to improve postoperatively (OR 0.3, p = 0.042). CONCLUSIONS Fibrous tissue was ubiquitous and may be important in the pathophysiology of TCS. Nerve twigs and adipose tissue were associated with abnormal urodynamics and low-lying coni, respectively. Although the majority of patients clinically improved, patients with normal conus levels had significantly better outcomes.
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KOO BN, HONG JY, SONG HT, KIM JM, KIL HK. Ultrasonography reveals a high prevalence of lower spinal dysraphism in children with urogenital anomalies. Acta Anaesthesiol Scand 2012; 56:624-8. [PMID: 22338610 DOI: 10.1111/j.1399-6576.2011.02612.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2011] [Indexed: 01/25/2023]
Abstract
BACKGROUND Lower spinal dysraphism is frequently reported in anorectal anomaly combined with urogenital anomalies. The prevalence of the spinal dysraphism has not been comprehensively studied in children with simple urogenital anomalies. We evaluated the prevalence of the spinal dysraphism using ultrasound data of the lumbosacral area in children with urogenital anomalies. METHODS Lumbosacral ultrasound images of 259 children who underwent urological surgery with simple urogenital anomalies were reviewed by an ultrasound-specialized radiologist. The primary outcome measures were the conus medullaris (CM) level and the thickness of the filum terminale. The spinal ultrasonographic findings that were assessed in children showed abnormal spinal findings compared with the other children having normal findings. Two years later, the follow-up telephone interviews were made with the parents of the children with abnormal findings. RESULTS Eighteen children were differentiated as the abnormal finding group. They were suspected of spinal cord tethering. The level of CM was lower, and the filum terminale was thicker compared to the normal group [L2(lower (L)) vs. L1(L), 2.2 mm vs. 0.8 mm]. Of eighteen children, four were confirmed as tethered spinal cord with lipoma on magnetic resonance imaging by the time of surgery, and two were strongly suspected of occult spinal dysraphism (OSD) based on ultrasound findings and follow-up interviews. CONCLUSIONS The prevalence of OSD in children under 24 months of age with simple urogenital anomaly was higher than what was reported for the general population. Ultrasound examination of spinal structures before caudal block in children with urogenital anomaly should be considered.
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Affiliation(s)
- B.-N. KOO
- Department of Anaesthesiology & Pain Medicine; Anaesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul; Korea
| | - J.-Y. HONG
- Department of Anaesthesiology and Pain Medicine; University of Ulsan College of Medicine, Asan Medical Center; Seoul; Korea
| | - H.-T. SONG
- Department of Radiology; Yonsei University College of Medicine; Seoul; Korea
| | - J. M. KIM
- Department of Anaesthesiology & Pain Medicine; Anaesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul; Korea
| | - H. K. KIL
- Department of Anaesthesiology & Pain Medicine; Anaesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul; Korea
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Ailawadhi P, Kale SS, Agrawal D, Mahapatra AK, Kumar R. Primary tethered cord syndrome--clinical and urological manifestations, diagnosis and management: a prospective study. Pediatr Neurosurg 2012; 48:210-5. [PMID: 23713055 DOI: 10.1159/000345829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 11/01/2012] [Indexed: 11/19/2022]
Abstract
Primary tethered cord syndrome refers to a group of neural tube defects that are not externally obvious, and, if detected at an early age, surgical intervention may prevent the significant irreversible neurological deficits. This study was performed to evaluate the presenting clinical features of patients with primary tethered cord syndrome and the indications of surgery in such patients as well as the clinical and urological outcome. In all cases, the indication for surgery was the presence of a tethered cord on magnetic resonance imaging, the criteria for tethering being a low-lying conus (below L1-L2) and a thickened filum (>2 mm). Urodynamic studies were performed before detethering. Microsurgical detethering of low-lying cord was then performed, and the patients were then followed clinically and urologically for 6 months. Pain responded the most to detethering while limb weakness and urological symptoms responded the least. Clinical improvement in urological symptoms correlated with improvement in urodynamic parameters. A urodynamic study identified improvement in a larger number of patients and also deterioration in a few patients which was not visible clinically; this may point to its high sensitivity and usefulness in preceding clinical manifestations in a future follow-up.
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Affiliation(s)
- Pankaj Ailawadhi
- Department of Neurosurgery and Urology, All India Institute of Medical Sciences, New Delhi, India
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Gluncic V, Turner M, Burrowes D, Frim D. Concurrent Chiari decompression and spinal cord untethering in children: feasibility in a small case series. Acta Neurochir (Wien) 2011; 153:109-14; discussion 114. [PMID: 20886245 DOI: 10.1007/s00701-010-0811-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 09/16/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE We describe the rationale and safety of concurrent decompression of Chiari type 1 malformation (CM1) and untethering of the spinal cord. Spinal cord traction is considered one of the pathogenic mechanisms involved in the development of CM, and 14% of patients with CM1 have tethered cord syndrome (Milhorat et al., Surg Neurol 7:20-35, 2009; Roth, Neuroradiology 21:133-138, 1981; Royo-Salvador, Rev Neurol 24:937-959, 1996; Royo-Salvador et al., Acta Neurochir 147:515-523, 2005). Therefore, intraspinal anomalies that require intervention are commonly treated before surgical decompression of Chiari malformation (Cheng et al., Neurologist 8:357-362, 2002; Menezes, Pediatr Neurosurg 23:260-269, 1995; Milhorat et al., Surg Neurol 7:20-35, 2009; Royo-Salvador et al., Acta Neurochir 147:515-523, 2005; Schijman and Steinbok, Childs Nerv Syst 20:341-348, 2004; Yamada et al., Neurol Res 26:719-721, 2004). However, in the interval between the spinal cord untethering and the decompression surgery, patients may continue to suffer from the untreated symptoms of CM. In a series of four patients with concurrent severe and progressive symptoms referable to both conditions, we performed both surgeries simultaneously. METHODS Charts of four patients who underwent concurrent Chiari decompression and spinal cord untethering were reviewed. RESULTS All patients tolerated the procedures well without complication. They reported significant or complete early postsurgical resolution of headaches and ambulating difficulties. On average, patients started to walk on postoperative day 3 (3 ± 1 days) and were discharged on hospital day 6 (6 ± 1 days). No patient experienced a persistent subcutaneous or transcutaneous cerebrospinal fluid leak. Subsequent postoperative courses were uneventful. CONCLUSION Concurrent Chiari decompression and untethering of the spinal cord is a feasible option and in some patients may be preferred in lieu of staged procedures.
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