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Yang X, Sun S, Ji Y, Xu Y, Sun L, Wu Q. Fetal Tethered Spinal Cord: Diagnostic Features and Its Association with Congenital Anomalies. Fetal Pediatr Pathol 2023; 42:557-568. [PMID: 36719707 DOI: 10.1080/15513815.2023.2172632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE We assessed the frequency and type of associated congenital anomalies encountered with fetal tethered spinal cord (TSC) determined prenatally. METHOD A retrospective review was conducted based on the associated fetal abnormalities following diagnosis of low-lying fetal conus medullaris during the prenatal ultrasound. RESULTS Of the 26 fetuses with low-lying conus medullaris, four were solitary TSC and 22 had TSC combined with associated congenital malformations, including four cases with spina bifida occulta, four cases with spina bifida aperta, one case with severe hydrocephalus, and 13 cases with multisystem congenital malformations. Among all the 13 cases with combined multisystem congenital malformations, four cases had vertebral defects, anal anomalies, cardiac defects, trachea-esophageal fistula, renal anomalies, and limb anomalies (VACTERL) syndrome, two cases had combined kidney development abnormalities, one case had cloacal exstrophy (OEIS syndrome), and six cases had chromosomal abnormalities (one case of chromosome 7q deletion, two cases of trisomy 13 syndrome, one case of trisomy 18 syndrome, one case of trisomy 9 syndrome, and one case of chromosome 4p deletion). CONCLUSIONS Low-lying conus medullaris found during prenatal ultrasound examination were often associated with neural tube malformations or multi-systemic complex developmental malformations. The frequency of chromosomal abnormalities was 23.1%.
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Affiliation(s)
- Xiaomei Yang
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Shiyu Sun
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Yizheng Ji
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Yasong Xu
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Li Sun
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Qichang Wu
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
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Zhang Z, Chang H, Liu K, Zhang D, Xue R, Li H, Wang Z, Liang G, Meng X. Is Intervertebral Disc Degeneration a Compensatory Mechanism in Adult Tethered Cord Syndrome? World Neurosurg 2023; 175:e511-e519. [PMID: 37028480 DOI: 10.1016/j.wneu.2023.03.134] [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] [Received: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE The purpose of the present study was to evaluate the influence of high nerve tension on lumbar disc degeneration and sagittal morphologies. MATERIALS AND METHODS A total of 50 young and middle-aged patients (mean age 32.1 ± 7.4 years, 22 men and 28 women) who suffered from tethered cord syndrome (TCS) were retrospectively assessed by two observers. Demographic and radiological data were recorded, including lumbar disc degeneration, disc height index and lumbar spine angle, and were compared with 50 patients (mean age 29.7 ± 5.4 years, 22 men and 28 women) without spinal cord abnormalities. Statistical associations were assessed by student's t-test and chi-square test. RESULTS Our results showed patients with TCS had a significantly higher rate of lumbar disc degeneration in L1/2, L2/3, L4/5 and L5/S1 than in those without TCS (P < 0.05). Moreover, the rates of multilevel disc degeneration and severe disc degeneration in TCS group were significantly higher than those in control group (P < 0.01). The mean disc height index of L3/4 and L4/5 in TCS group was significantly lower than that in control group (P < 0.05). The mean lumbosacral angle of TCS patients was significantly higher than that of patients without TCS (38.4 ± 3.5°vs. 33.7 ± 5.9°, P < 0.01). CONCLUSIONS We found a certain correlation between TCS and lumbar disc degeneration and lumbosacral angle enlargement, suggesting that the spine reduces the high tension of the spinal cord through disc degeneration. Therefore, it is speculated that there is a "compromised regulation" mechanism in the body under the condition of neurological abnormalities.
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Affiliation(s)
- Zhuang Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hengrui Chang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kaiyu Liu
- Department of Orthopaedic Surgery, Chengde Medical College, Hebei, China
| | - Di Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Rui Xue
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Haoran Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhaoxuan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Guzhen Liang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xianzhong Meng
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Leopold KN, Ahn ES, Youssef MJ, Gregory SW. Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft. Pediatr Rev 2021; 42:e41-e44. [PMID: 34599061 DOI: 10.1542/pir.2020-002162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Molly J Youssef
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
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Lee SH, Shin HI, Nam TK, Park YS, Kim DK, Kwon JT. Growth profile assessment of young adults with tethered cord syndrome: a retrospective cohort analysis of Korean conscription data. Childs Nerv Syst 2021; 37:1973-1981. [PMID: 33392650 DOI: 10.1007/s00381-020-05026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/20/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Tethered cord syndrome (TCS) is characterized by progressive spinal cord degeneration secondary to congenital spinal dysraphism. The associated accompanying physical inactivity and musculoskeletal deformities have raised interest in the growth profile of adult TCS patients. However, few previous studies have investigated the growth profile of adult TCS patients. METHODS We retrospectively reviewed the demographic data and medical records of 20-year-old Korean conscription examinees who were registered between April 2004 and September 2019. In total, 151 examinees with a diagnosis of TCS were enrolled. The height, weight, and body mass index (BMI) of 300 randomly selected examinees were compared to the TCS group. Obesity was defined by the World Health Organization and Asian-Pacific criteria for BMI and compared between the groups. Growth profile differences according to tethering location and musculoskeletal deformities were analyzed in both groups. RESULTS The mean height, weight, and BMI values of the TCS group were lower than those of the control group. The TCS group had a lower proportion of obese and overweight individuals, and a higher proportion of underweight individuals, according to both BMI criteria. The tethering level was not associated with the degree of obesity in the tethered group. The mean height, weight, and BMI were lower in the tethered group regardless of the existence of musculoskeletal deformity. CONCLUSION Enrollees with a history of TCS were smaller than controls of the same age. Monitoring of health behaviors, including nutrition, diet, and exercise, is warranted for TCS patients.
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Affiliation(s)
- Shin Heon Lee
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea
| | - Hyun Iee Shin
- Department of Rehabilitation Medicine, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea.
| | - Taek-Kyun Nam
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea
| | - Yong-Sook Park
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea
| | - Don-Kyu Kim
- Department of Rehabilitation Medicine, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea
| | - Jeong-Taik Kwon
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea
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Huang Z, Li X, Deng Y, Sui W, Fan H, Yang J, Yang J. The Treatment of Severe Congenital Scoliosis Associated With Type I Split Cord Malformation: Is a Preliminary Bony Septum Resection Always Necessary? Neurosurgery 2019; 85:211-222. [PMID: 30060239 DOI: 10.1093/neuros/nyy237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/16/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Single-stage spine-shortening osteotomy without treating spinal cord malformations may have potential advantages for the treatment of severe congenital scoliosis (CS) with type I split spinal cord malformation (SSCM); however, the study of this technique was limited. OBJECTIVE To evaluate the safety and efficacy of a single-stage spine-shortening osteotomy in the treatment of severe CS associated with type I SSCM. METHODS A retrospective study was designed to compare 2 case series including 12 severe CS patients with type I SSCM and 26 patients with type A cord function (without spinal cord malformations, evoked potential abnormalities, and neurological dysfunctions preoperatively) treated with a single-stage spine-shortening posterior vertebral column resection (PVCR). Patient demographic, clinical, operative, and radiographic data were obtained and compared between groups. RESULTS The surgical procedure was successfully performed in both groups, and the patients were observed for an average of 44.9 mo (range 25-78 mo) after the initial surgery. The radiographic parameters, intraoperative data, and new neurological deficits showed no difference, while deformity angular ratio (SSCM group: control group = 16.6 ± 3.6: 20.1 ± 3.9, P = .01) and corrective rate (SSCM group: control group = 50%: 58%, P = .046) of the main curve were statistically different between groups. All of the new neurological deficits were recovered within 1 yr. CONCLUSION The single-stage spine-shortening PVCR with moderate correction could be applied to the treatment of CS associated with type I SSCM. This strategy can achieve safe spinal deformity correction while obviate the neurological complications brought by the detethering procedures, which merits further clinical investigation.
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Affiliation(s)
- Zifang Huang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xueshi Li
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yaolong Deng
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Spine Surgery Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenyuan Sui
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Spine Surgery Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hengwei Fan
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingfan Yang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Spine Surgery Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junlin Yang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Spine Surgery Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Choi JH, Lee T, Kwon HH, You SK, Kang JW. Outcome of ultrasonographic imaging in infants with sacral dimple. KOREAN JOURNAL OF PEDIATRICS 2018; 61:194-199. [PMID: 29963103 PMCID: PMC6021363 DOI: 10.3345/kjp.2018.61.6.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 11/27/2022]
Abstract
Purpose Sacral dimples are a common cutaneous anomaly in infants. Spine ultrasonography (USG) is an effective and safe screening tool for patients with a sacral dimple. The aim of this study was to determine the clinical manifestations in patients with an isolated sacral dimple and to review the management of spinal cord abnormalities identified with USG. Methods We reviewed clinical records and collected data on admissions for a sacral dimple from March 2014 through February 2017 that were evaluated with spine USG by a pediatric radiologist. During the same period, patients who were admitted for other complaints, but were found to have a sacral dimple were also included. Results This study included 230 infants under 6-months-old (130 males and 100 females; mean age 52.8±42.6 days). Thirty-one infants with a sacral dimple had an echogenic filum terminale, and 57 children had a filar cyst. Twenty-seven patients had a low-lying spinal cord, and only one patient was suspected of having a tethered cord. Follow-up spine USG was performed in 28 patients, which showed normalization or insignificant change. Conclusion In this study, all but one infant with a sacral dimple had benign imaging findings. USG can be recommended in infants with a sacral dimple for its convenience and safety.
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Affiliation(s)
- Jin Hyuk Choi
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Taekwan Lee
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyeok Hee Kwon
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun Kyoung You
- Department of Radiology, Chungnam National University Hospital, Daejeon, Korea
| | - Joon Won Kang
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Korea.,Brain Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
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7
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Zhao D, Wei Q, Cai A, Xie L, Wang B, Wang X. Prenatal Assessment of the Position of Fetal Conus Medullaris as a Predictor of Fetal Spinal Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:201-207. [PMID: 28708311 DOI: 10.1002/jum.14326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/19/2017] [Accepted: 04/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study is to compare two different methods in assessment of the position of fetal conus medullaris (CM) and to explore the significance for assessment of CM. METHODS This study included both normal fetuses and those with the diagnosis of fetal spinal lesions. The position of fetal CM was performed sonographically using two methods: location of CM in relation to the vertebral body (CM level) and measurement of the conus sacrum (CS) distance. RESULTS The results showed that intra-observer and interobserver concordance was high for the two methods, both in the normal and abnormal groups. There was significant association between femur length and CS distance (R2 = 0.917) and between gestational age and CS distance (R2 = 0.892). CONCLUSIONS We propose the combined use of CM level location and CS distance measurement for the prenatal diagnosis of fetal spinal lesions for complementary needs.
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Affiliation(s)
- Dan Zhao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiuju Wei
- Department of Ultrasound, Fushun Hospital of Shengjing Hospital Group of CMU, Fushun, China
| | - Ailu Cai
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Limei Xie
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bing Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoguang Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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8
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De Decker S, Watts V, Neilson DM. Dynamic Lumbosacral Magnetic Resonance Imaging in a Dog with Tethered Cord Syndrome with a Tight Filum Terminale. Front Vet Sci 2017; 4:134. [PMID: 28868301 PMCID: PMC5563312 DOI: 10.3389/fvets.2017.00134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 08/03/2017] [Indexed: 11/13/2022] Open
Abstract
A 1-year and 11-month- old English Cocker Spaniel was evaluated for clinical signs of progressive right pelvic limb lameness and urinary incontinence. Neurological examination was suggestive of a lesion localized to the L4–S3 spinal cord segments. No abnormalities were seen on magnetic resonance imaging (MRI) performed in the dog in dorsal recumbency and the hips in a neutral position and the conus medullaris ended halfway the vertebral body of L7. An MRI of the hips in extended and flexed positions demonstrated minimal displacement of the conus medullaris in the cranial and caudal directions, respectively. Similar to the images in neutral position, the conus medullaris ended halfway the vertebral body of L7 in both the extended and flexed positions. In comparison, an MRI of the hips in neutral, extended, and flexed positions performed in another English Cocker Spaniel revealed obvious cranial displacement of the conus medullaris with the hips in extension and caudal displacement with hips in flexion. A standard dorsal lumbosacral laminectomy was performed. Visual inspection of the vertebral canal revealed excessive caudal traction on the conus medullaris. After sectioning the distal aspect of the filum terminale, the conus medullaris regained a more cranial position. A neurological examination 4 weeks after surgery revealed clinical improvement. Neurological examinations at 2, 4, 7, and 12 months after surgery did not reveal any abnormalities, and the dog was considered to be clinically normal. Tethered cord syndrome with a tight filum terminale is a very rare congenital anomaly and is characterized by an abnormally short and inelastic filum terminale. Therefore, this disorder is associated with abnormal caudal traction on the spinal cord and decreased physiological craniocaudal movements of the neural structures within the vertebral canal. Although further studies are necessary to evaluate and quantify physiological craniocaudal movement of the spinal cord and conus medullaris in neurologically normal dogs, the results of this report suggest further exploration of dynamic MRI to demonstrate decreased craniocaudal displacement of the conus medullaris in dogs with tethered cord syndrome with a tight filum terminale.
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Affiliation(s)
- Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, United Kingdom
| | - Vicky Watts
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, United Kingdom
| | - David M Neilson
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, United Kingdom
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10
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Alvarado E, Leach J, Caré M, Mangano F, O Hara S. Pediatric Spinal Ultrasound: Neonatal and Intraoperative Applications. Semin Ultrasound CT MR 2017; 38:126-142. [PMID: 28347416 DOI: 10.1053/j.sult.2016.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this article is to review the use of ultrasound as a screening tool for spinal diseases in neonates and infants and its intraoperative value in selected pediatric neurosurgical disorders. A review of spinal embryology followed by a description of common spinal diseases in neonates assessed with ultrasound is presented. Indications for spinal ultrasound in neonates, commonly identified conditions, and the importance of magnetic resonance imaging in selected cases are emphasized. Additionally, the use of ultrasound in selected neurosurgical spinal diseases in pediatric patients is presented with magnetic resonance imaging and intraoperative correlation. Technique, limitations, and pitfalls are discussed.
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Affiliation(s)
- Enrique Alvarado
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - James Leach
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH.
| | - Marguerite Caré
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - Francesco Mangano
- Department of Neurosurgery, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - Sara O Hara
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
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Lower urinary tract dysfunction in patients with peripheral nervous system lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:203-24. [PMID: 26003246 DOI: 10.1016/b978-0-444-63247-0.00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
The prevalence of lower urinary tract (LUT) dysfunction in peripheral nervous system (PNS) disorders is larger than in comparable control populations. This is particularly true for polyneuropathies with autonomic nervous system involvement, and for localized lesions with LUT innervation. LUT symptoms may be the guide to the diagnosis of processes localized in the lumbosacral spinal canal (as in cauda equina syndrome), and in the pelvis. Typical LUT dysfunctions (LUTD) caused by PNS involvement include bladder and sphincter hypoactivity with poor emptying, and incontinence. Paradoxically, bladder overactivity may also occur in pure PNS lesions. The acute cauda equina syndrome is an emergency requiring magnetic resonance imaging and surgery; in chronic neurogenic LUTD due to PNS involvement, the diagnosis of the lesion may be clarified by clinical neurophysiologic testing. Other important causes of neurogenic LUT dysfunction are perineoabdominal and pelvic surgeries. Surgeons are devising nerve-sparing techniques to prevent such major and often persistent complications in patients who are otherwise cured of the underlying disease. LUTD significantly affects the quality of life in patients and may lead to recurring urinary infections and upper urinary tract involvement. Thorough assessment of LUT function by urodynamics may be necessary in patients who are not improved by simple conservative measures.
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12
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Shweikeh F, Al-Khouja L, Nuño M, Johnson JP, Drazin D, Adamo MA. Disparities in clinical and economic outcomes in children and adolescents following surgery for tethered cord syndrome in the United States. J Neurosurg Pediatr 2015; 15:427-33. [PMID: 25559922 DOI: 10.3171/2014.9.peds14241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Tethered cord syndrome (TCS) is a common spinal abnormality. In this study, the authors analyzed demographics, complications, and outcomes in children and adolescents who underwent surgery for TCS. METHODS Using the national Kids' Inpatient Database (KID), the authors retrospectively identified patients with a primary diagnosis of TCS who were treated with spinal laminectomy and discharged in 2000, 2003, 2006, and 2009. Descriptive analysis was provided for patient- and hospital-level characteristics. Mortality, complications, non-routine discharges, in-hospital length of stay (LOS), and total charges were documented for the entire cohort and age-specific cohorts (0-5, 6-10, 11-15, and 16-20 years). Comparisons by complications and age groups were conducted. RESULTS A total of 7397 children and adolescents met the criteria in the 4 studied years. The mean age was 5.7 years; 55.3% of patients were younger than 5 years, 21.5% were 6-10 years, and 16.2% were 11-15 years. Most surgeries were performed in patients who were female (55.0%) and white (64.4%) and were performed at large (49.8%), teaching (94.2%), and urban (99.1%) children's (89.3%) hospitals. The trend showed an increase in prevalence from 2000 (19.9%) to 2009 (29.6%). Common comorbidities included anomalies in spinal curvature (16.7%), urinary or bladder dysfunction (14.3%), and spinal stenosis/spondylosis (1.4%). Non-routine discharges (3.3%) were significantly higher with advancing age, increasing from 2.2% in those younger than 5 years to 9.0% in those older than 15 years (p < 0.0001). There was a similar increasing trend for complications (6.8% to 13.9%, respectively, p < 0.0001) and average LOS (3.5 to 5.1 days, respectively, p < 0.0001). Hospital charges increased with age from an average of $28,521 in those younger than 5 years to $36,855 in those older than 15 years (p < 0.0001). CONCLUSIONS There was a steady trend of increasing operative treatment for TCS over the more recent years. The nationwide analysis was also indicative of an existing disparity, based on age, in complications, outcomes, and charges following TCS surgical correction. Older children tended to have more complications, longer LOS, more non-routine discharges, and higher hospital costs. The results are highly supportive of surgery at a younger age for this condition. Future research should investigate this correlation, especially considering the efforts to control and reduce health care costs.
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Affiliation(s)
- Faris Shweikeh
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles
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13
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De Decker S, Gregori T, Kenny PJ, Hoy C, Erles K, Volk HA. Tethered cord syndrome associated with a thickened filum terminale in a dog. J Vet Intern Med 2015; 29:405-9. [PMID: 25586550 PMCID: PMC4858091 DOI: 10.1111/jvim.12522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/28/2014] [Accepted: 11/11/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- S De Decker
- Department of Veterinary Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, England
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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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Lei T, Xie HN, Zheng J, Feng JL, Du L, Wang N. Prenatal evaluation of the conus medullaris position in normal fetuses and fetuses with spina bifida occulta using three-dimensional ultrasonography. Prenat Diagn 2014; 34:564-9. [PMID: 24604267 DOI: 10.1002/pd.4349] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/21/2014] [Accepted: 02/26/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Ting Lei
- Department of Ultrasonic Medicine, Fetal Medical Centre; the First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Hong-Ning Xie
- Department of Ultrasonic Medicine, Fetal Medical Centre; the First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Ju Zheng
- Department of Ultrasonic Medicine, Fetal Medical Centre; the First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Jie-Ling Feng
- Department of Ultrasonic Medicine, Fetal Medical Centre; the First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Liu Du
- Department of Ultrasonic Medicine, Fetal Medical Centre; the First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Nan Wang
- Department of Ultrasonic Medicine, Fetal Medical Centre; the First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
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16
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Cornips EMJ, Vereijken IMP, Beuls EAM, Weber JW, Soudant DLHM, van Rhijn LW, Callewaert PRH, Vles JSH. Clinical characteristics and surgical outcome in 25 cases of childhood tight filum syndrome. Eur J Paediatr Neurol 2012; 16:103-17. [PMID: 21835656 DOI: 10.1016/j.ejpn.2011.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 07/18/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Tight filum syndrome (TFS) is caused by a thick (abnormal T1 MRI), shortened (low-lying conus), or non-elastic filum (strictly normal MRI). We carefully analyzed children treated for suspect TFS with or without radiological abnormalities. METHODS Twenty-five children, operated between 2002 and 2009, were retrospectively identified. All children had been evaluated by a multidisciplinary team preoperatively. Symptoms, signs and diagnostic test results were categorized (neurologic, urologic, orthopedic, dermatologic) and compared pre- and one year postoperatively. Normal MR was defined as conus medullaris (CM) at or above mid-body L2 and filum diameter less than 2 mm. Occult TFS (OTFS) was defined as TFS with normal MR. DEMOGRAPHICS 17 girls, 8 boys, age 2-18 years, including 11 syndromal children. CLINICAL PRESENTATION all children had problems in the neurologic category and at least one other category: urologic (n = 17), orthopedic (n = 21), and dermatologic (n = 11). MR findings: low-lying CM (n = 14) including 2 with thick filum, normal CM but fatty filum (n = 2), strictly normal (n = 9). Clinical outcome one year postoperatively: neurologic 20 improved, 5 stabilized; urologic 13 improved, 3 stabilized, 1 worsened; orthopedic (8 children presenting with scoliosis) 3 improved, 4 stabilized, 1 worsened. All children with OTFS (n = 9) improved in at least one and 8 improved in all affected categories. CONCLUSIONS Children with strong clinical suspicion for TFS (≥ 2 affected categories) with or without abnormal MR findings will likely benefit from surgery. In such cases we suggest a detailed full spine MR, a multidisciplinary diagnostic work-up, and eventual untethering through an interlaminar microsurgical approach.
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Affiliation(s)
- Erwin M J Cornips
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
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17
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Jiang J, Zhu Z, Qian B, Liu Z, Qiu Y. Anterior cervical myelomeningocele: a rare malformation of the spinal cord. J Neurosurg Spine 2011; 16:257-60. [PMID: 22150240 DOI: 10.3171/2011.10.spine11484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cervical myelomeningocele (MMC) is an uncommon congenital malformation of the spinal cord and accounts for a small proportion of neural tube defects. These lesions mostly occur in the dorsal part of the body. Only a single case of an anterior cervical MMC has been previously reported. The authors report a second case of anterior cervical MMC diagnosed when the patient began to experience symptoms of bilateral hand weakness in adulthood. In this patient, MR imaging of the cervical spine showed an anterior cervical MMC at the C6-7 level with hydrocephalus, thinning of the genu and trunk of the corpus callosum, maldevelopment of the cerebellar tonsils, and expansion of the fourth ventricle, posterior cranial fossa, and subarachnoid space. A CT scan and a 3D CT reconstruction of the cervical spine clearly demonstrated contiguous fusions of multiple lower-cervical vertebrae and neural arches, which was consistent with Type III Klippel-Feil syndrome. The patient was advised to undergo operative treatment to prevent the progression of her neurological deficit. However, after being notified of the potential neurological risks, the patient declined surgery and opted for conservative treatment with a hard neck collar. At 4 months' follow-up, the patient's neurological deficit remains stable with the MMC left untreated. The authors presume that the possible pathogenesis of anterior cervical MMC may greatly differ from that of posterior lesions. This lesion could also be associated with multiple other spinal abnormalities, which highlights the importance of comprehensive preoperative radiological examinations.
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Affiliation(s)
- Jun Jiang
- Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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18
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Filippidis AS, Kalani MY, Theodore N, Rekate HL. Spinal cord traction, vascular compromise, hypoxia, and metabolic derangements in the pathophysiology of tethered cord syndrome. Neurosurg Focus 2010; 29:E9. [PMID: 20594007 DOI: 10.3171/2010.3.focus1085] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The definition of tethered cord syndrome (TCS) relies mainly on radiological criteria and clinical picture. The presence of a thickened filum terminale and a low-lying conus medullaris in symptomatic patients is indicative of TCS. The radiological definition of TCS does not take into account cases that involve a normal-lying conus medullaris exhibiting symptoms of the disease. METHODS The authors performed a MEDLINE search using the terms "tethered cord" and "pathophysiology." The search returned a total of 134 studies. The studies were further filtered to identify mostly basic research studies in animal models or studies related to the biomechanics of the filum terminale and spinal cord. RESULTS Spinal cord traction and the loss of filum terminale elasticity are the triggers that start a cascade of events occurring at the metabolic and vascular levels leading to symptoms of the disease. Traction on the caudal cord results in decreased blood flow causing metabolic derangements that culminate in motor, sensory, and urinary neurological deficits. The untethering operation restores blood flow and reverses the clinical picture in most symptomatic cases. CONCLUSIONS Although classically defined as a disease of a low-lying conus medullaris, the pathophysiology of TCS is much more complex and is dependent on a structural abnormality, with concomitant altered metabolic and vascular sequelae. Given the complex mechanisms underlying TCS, it is not surprising that the radiological criteria do not adequately address all presentations of the disease.
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Affiliation(s)
- Aristotelis S Filippidis
- Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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19
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Abstract
Tethered spinal cord is associated with closed and open neural tube defects. With prenatal screening, spinal defects are consistently diagnosed during fetal life. We show that the conus medullaris can be seen well with prenatal ultrasound, and the diagnosis of tethered spinal cord can be made during fetal life. In this pictorial essay, we show examples of tethered cord in a variety of fetuses with spine anomalies.
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20
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Lacout A, Perrier Y, Mompoint D, Vallée CA, Carlier RY. [Answer to January e-quid. Low-lying cord: a rare cause of paraplegia. Diagnosis: tethered cord]. JOURNAL DE RADIOLOGIE 2010; 91:241-243. [PMID: 20389275 DOI: 10.1016/s0221-0363(10)70033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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21
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Cornips EMJ, Razenberg FGEM, van Rhijn LW, Soudant DLHM, van Raak EPM, Weber JW, Robben SG, Fock JM, Catsman-Berrevoets CE, Vles JSH. The lumbosacral angle does not reflect progressive tethered cord syndrome in children with spinal dysraphism. Childs Nerv Syst 2010; 26:1757-64. [PMID: 20857121 PMCID: PMC2981732 DOI: 10.1007/s00381-010-1281-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 09/09/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Our goal was to validate the hypothesis that the lumbosacral angle (LSA) increases in children with spinal dysraphism who present with progressive symptoms and signs of tethered cord syndrome (TCS), and if so, to determine for which different types and/or levels the LSA would be a valid indicator of progressive TCS. Moreover, we studied the influence of surgical untethering and eventual retethering on the LSA. METHODS We retrospectively analyzed the data of 33 children with spinal dysraphism and 33 controls with medulloblastoma. We measured the LSA at different moments during follow-up and correlated this with progression in symptomatology. RESULTS LSA measurements had an acceptable intra- and interobserver variability, however, some children with severe deformity of the caudal part of the spinal column, and for obvious reasons those with caudal regression syndrome were excluded. LSA measurements in children with spinal dysraphism were significantly different from the control group (mean LSA change, 21.0° and 3.1° respectively). However, both groups were not age-matched, and when dividing both groups into comparable age categories, we no longer observed a significant difference. Moreover, we did not observe a significant difference between 26 children with progressive TCS as opposed to seven children with stable TCS (mean LSA change, 20.6° and 22.4° respectively). CONCLUSIONS We did not observe significant differences in LSA measurements for children with clinically progressive TCS as opposed to clinically stable TCS. Therefore, the LSA does not help the clinician to determine if there is significant spinal cord tethering, nor if surgical untethering is needed.
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Affiliation(s)
- Erwin M. J. Cornips
- Department of Neurosurgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Femke G. E. M. Razenberg
- Department of Child Neurology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Lodewijk W. van Rhijn
- Department of Orthopaedic Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Dan L. H. M. Soudant
- Department of Child Neurology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Elisabeth P. M. van Raak
- Department of Neurology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Jacobiene W. Weber
- Department of Child Neurology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Simon G. Robben
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johanna M. Fock
- Department of Child Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Johannes S. H. Vles
- Department of Child Neurology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
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23
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Caird J, Flynn P, McConnell RS. Significant clinical and radiological resolution of a spinal cord syrinx following the release of a tethered cord in a patient with an anatomically normal conus medullaris. Case report. J Neurosurg Pediatr 2008; 1:396-8. [PMID: 18447677 DOI: 10.3171/ped/2008/1/5/396] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe a case of progressive neurological deficit caused by syringomyelia in a 7-year-old boy with a normally positioned conus medullaris. This deficit responded favorably to surgical untethering of the filum terminale, with subsequent clinical and radiological improvement. The authors discuss the implications of their findings in the context of the current understanding of the pathophysiology of tethered cord syndrome, particularly in relation to the ongoing debate in the neurosurgical literature.
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Affiliation(s)
- John Caird
- Department of Neurosurgery, Royal Victoria Hospital, Belfast, United Kingdom
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24
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Blount JP, Tubbs RS, Wellons JC, Acakpo-Satchivi L, Bauer D, Oakes WJ. Spinal cord transection for definitive untethering of repetitive tethered cord. Neurosurg Focus 2008; 23:E12. [PMID: 17961007 DOI: 10.3171/foc-07/08/e12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In certain highly selected circumstances, division of a distally nonfunctional or dysfunctional cord can be a means of definitive untethering that spares and protects more rostral neurological function and results in definitive untethering. The authors reviewed their institutional experience with such cases and evaluated the limited literature. Based on their experience, treatment can be effective in carefully selected patients who undergo spinal cord transection, and the rate of repetitive tethered spinal cord can be decreased.
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Affiliation(s)
- Jeffrey P Blount
- Section of Pediatric Neurosurgery, University of Alabama at Birmingham and Children's Hospital, Birmingham, Alabama 35233, USA
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25
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Abstract
✓The treatment of a patient with symptoms of a tethered spinal cord and in whom a fatty infiltrated terminal filum is found is controversial. The authors review their experience and the literature regarding this aspect of occult spinal dysraphism. From experience, transection of a fatty terminal filum in patients with symptoms related to excessive caudal cord tension is a minor procedure that generally yields good results. The most problematic issue in the literature is what patients and symptoms are best suited to surgical treatment.
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Affiliation(s)
| | - R. Shane Tubbs
- 1Section of Pediatric Neurosurgery,
- 2Department of Cell Biology, University of Alabama at Birmingham and Children's Hospital, Birmingham, Alabama
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26
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Abstract
Spinal surgery is performed in children of all age groups. Some of these children will have significant, other medical problems. For most, surgery will be performed in the prone position. Blood loss may be high for some types of surgery, and patients will benefit from use of a blood-sparing technique. Many patients will require spinal cord monitoring to assess cord function and to prevent neurological deficit.
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Affiliation(s)
- N Soundararajan
- Jackson Rees Department of Paediatric Anaesthesia, Royal Liverpool Children's Hospital - Alder Hey, Eaton Road, Liverpool L12 2AP, UK
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27
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Abstract
The complexity of the congenital anomalies of the spine can make the neuroradiologic diagnosis challenging. Knowledge of spinal embryology greatly helps in the understanding and classification of these anomalies. We use the classification devised by Tortori-Donati and Rossi and find it helpful from clinical and imaging standpoints. We believe that most patients who have known or suspected congenital spinal anomalies benefit from MR imaging.
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Affiliation(s)
- John D Grimme
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7510, USA
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28
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Karikari IO, Uschold TD, Selznick LA, Carter JH, Cummings TJ, Friedman AH. PRIMARY SPINAL INTRAMEDULLARY ADRENAL CORTICAL ADENOMA ASSOCIATED WITH SPINAL DYSRAPHISM. Neurosurgery 2006; 59:E1144; discussion E1144. [PMID: 17143207 DOI: 10.1227/01.neu.0000245588.31334.83] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractOBJECTIVEThe authors report a primary spinal intramedullary adrenal cortical adenoma in a patient with spinal dysraphism presenting with bilateral leg pain and urinary frequency.METHODSMagnetic resonance imaging, L2 laminectomy with resection of mass, and pathological and immunohistochemical analysis of resected mass revealed the diagnosis.RESULTSMicroscopic and immunohistochemical findings confirmed the diagnosis as a primary intramedullary tumor of adrenal cortical origin.CONCLUSIONThe occurrence of a primary adrenal tumor in the spinal cord is rare and difficult to explain based on our understanding of embryology. A review of the relevant literature and discussion of the pathophysiology and clinical implications is provided.
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Affiliation(s)
- Isaac O Karikari
- Neurosurgery Service, Duke University Medical Center, Durham, North Carolina, USA
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Bademci G, Saygun M, Batay F, Cakmak A, Basar H, Anbarci H, Unal B. Prevalence of primary tethered cord syndrome associated with occult spinal dysraphism in primary school children in Turkey. Pediatr Neurosurg 2006; 42:4-13. [PMID: 16357495 DOI: 10.1159/000089503] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Accepted: 07/07/2005] [Indexed: 11/19/2022]
Abstract
The prevalence and associated factors of primary tethered cord syndrome (PTCS) in primary school children were investigated. A cross-sectional study was performed in four demographically different primary schools in Turkey. Demographic, familial and physical data were collected from 5,499 children based on enuresis as a predominant symptom and dermatologic and orthopedic signs as clues of occult spinal dysraphism. Statistical analysis and input of the data were carried out with the SPSS package program 10.00, and logistic regression analysis was used to identify discriminating factors between enuretic children with or without neurologic signs. Of 5,499 analyzed children, 422 (7.7%) had enuresis nocturna, and 19.9% of 422 children had also daytime incontinence. Sixteen of these 422 enuretic children (3.8%) had several dermatologic signs. Five of them had spina bifida on plain radiographies, and 4 of them had cord tethering on lumbar MRI. Fifteen of 422 enuretic children (3.7%) had gait disturbances and orthopedic anomalies without cutaneous manifestations. Six of 15 children had spina bifida on plain graphies and 2 of them had tethered cord syndrome on MRI. The general prevalence of PTCS was found to be 0.1% of 5,499 analyzed children and 1.4% of enuretic children. A good outcome after untethering was found in 83.0% in this series. Practitioners should be aware of these clues of occult spinal dysraphism and resort to further radiologic and neurosurgical assessment. Early surgical intervention may halt the progression of the neurologic deficits and stabilize or reverse symptoms.
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Affiliation(s)
- Gulsah Bademci
- Department of Neurosurgery, Faculty of Medicine, University of Kirikkale, Kirikkale, Turkey.
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