Change in Spinal Curvature following Release of Tethered Spinal Cord Associated with Spina bif ida

Reigel, Donald H.; Tchernoukha, Konstantin; Bazmi, B.; Kortyna, Rick; Rotenstein, Deborah

doi:10.1159/000120762

Cited by 78 publications

(41 citation statements)

References 10 publications

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“…None of our patients was found to have significant exaggeration of lumbar lordosis, although this curvature varies significantly in the general population and is difficult to define. 7 Analysis of data obtained in symptomatic and nonsymptomatic patients after surgical repair of their LMMC demonstrated a mean change in the LSA of 13 and 5˚, respectively. The standard deviation for the symptomatic group was 11.546˚, and for the nonsymptomatic group it was 8.174˚.…”

Section: Resultsmentioning

confidence: 96%

“…We found that mean perinatal measurement of this angle in our group of patients born, for example, with an LMMC, was 40˚, which may suggest an earlier alteration in the angulation of the sacrum in these patients preoperatively. Reigel et al 7 found that release of a tethered spinal cord alters the course of lordosis in upper lumbar lesions but had little effect on the normal progression of lordosis in patients with lower lumbar or sacral lesions. Indeed, we did not observe significant changes in the LSA following detethering procedures in many of our patients with LMMCs or MMCs, but radiographs or MR images are not routinely obtained postoperatively in patients with LMMCs.…”

Section: Abitbolmentioning

confidence: 99%

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The horizontal sacrum as an indicator of the tethered spinal cord in spina bifida aperta and occulta

Tubbs

Bui

Loukas

et al. 2007

FOC

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Object The authors report on symptomatic patients with myelomeningocele (MMC) and lipomyelomeningocele (LMMC) who were found to have changes in their lumbosacral angle (LSA) corresponding to the onset of symptoms indicative of a tethered spinal cord. Methods The authors review data obtained in these two cohorts of patients and compare the LSAs measured in the perinatal period with those seen when the patients presented with symptoms of a tethered spinal cord. Results Children with LMMC, roughly one third of studied cases, were symptomatic due to a tethered spinal cord at their most recent follow-up. In children in whom the MMC was the closed form at birth, 20 of 30 had symptoms that could be indicative of a tethered spinal cord at their most recent follow-up. The LSA was altered in both groups with symptoms. Conclusions Signs and symptoms indicative of a tethered spinal cord appear to correspond to increases in the LSA.

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Section: Resultsmentioning

confidence: 96%

Section: Abitbolmentioning

confidence: 99%

The horizontal sacrum as an indicator of the tethered spinal cord in spina bifida aperta and occulta

Tubbs

Bui

Loukas

et al. 2007

FOC

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“…None of the patients with curves > 40° or with an affected thoracic level demonstrated any benefit. Reigel et al 11 examined 216 patients with MM who were untethered and found none of those with thoracic level MM stabilized.…”

Section: Discussionmentioning

confidence: 99%

A patient with myelomeningocele: is untethering necessary prior to scoliosis correction?

Samdani¹,

Fine²,

Sagoo³

et al. 2010

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Object Tethering of the spinal cord is thought to increase the chance of neurological injury when scoliosis correction is undertaken. All patients with myelomeningocele (MM) are radiographically tethered, and untethering procedures carry significant morbidity risks including worsening neurological function and wound complications. No guidelines exist as regards untethering in patients with MM prior to scoliosis correction surgery. The authors' aim in this study was to evaluate their experience in patients with MM who were not untethered before scoliosis correction. Methods Seventeen patients with MM were retrospectively identified and 1) had no evidence of a clinically symptomatic tethered cord, 2) had undergone spinal fusion for scoliosis correction, and 3) had not been untethered for at least 1 year prior to surgery. The minimum follow-up after fusion was 2 years. Charts and radiographs were reviewed for neurological or shunt complications in the perioperative period. Results The average age of the patients was 12.4 years, and the following neurological levels were affected: T-12 and above, 7 patients; L-1/L-2, 6 patients; L-3, 2 patients; and L-4, 2 patients. All were radiographically tethered as confirmed on MR imaging. Fourteen of the patients (82%) had a ventriculoperitoneal shunt. The mean Cobb angle was corrected from 82° to 35°, for a 57% correction. All patients underwent neuromonitoring of their upper extremities, and some underwent lower extremity monitoring as well. Postoperatively, no patient experienced a new cranial nerve palsy, shunt malfunction, change in urological function, or upper extremity weakness/sensory loss. One patient had transient lower extremity weakness, which returned to baseline within 1 month of surgery. Conclusions The study results suggested that spinal cord untethering may be unnecessary in patients with MM who are undergoing scoliosis corrective surgery and do not present with clinical symptoms of a tethered cord, even though tethering is radiographically demonstrated.

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“…15 The most common clinical presentations for occult dysraphic states later in infancy include delay in development of sphincter control, delay in walking, asymmetry of the legs or abnormalities of the feet (ie, pes cavus and pes equinovarus), and pain in the back or lower extremities. 12,13,18,24,[35][36][37][38][39] Several studies have demonstrated improvement of the multiple symptoms associated with occult dysraphism if surgical intervention is performed. [23][24][25] Newborns with spinal dysraphism were divided into early and delayed diagnosis.…”

Section: Natural History and Surgical Interventionmentioning

confidence: 99%

Newborns With Suspected Occult Spinal Dysraphism: A Cost-Effectiveness Analysis of Diagnostic Strategies

2001

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ABSTRACT. Objective. To assess the clinical and economic consequences of different diagnostic strategies in newborns with suspected occult spinal dysraphism.Methods. A decision-analytic model was constructed to project the cost and health outcomes of magnetic resonance imaging (MRI), ultrasound (US), plain radiographs, and no imaging in newborns with suspected occult spinal dysraphism. Morbidity and mortality rates of early versus late diagnosis of dysraphism and the sensitivity and specificity of MRI, US, and plain radiographs were obtained from the literature. Cost estimates were obtained from a hospital cost accounting database and from the Medicaid fee schedule.Results. We found that the choice of imaging strategy depends on the underlying risk of occult spinal dysraphism. In low-risk children with intergluteal dimple or newborns of diabetic mothers (pretest probability: 0.3%-0.34%), US was the most effective strategy with an incremental cost-effectiveness ratio of $55 100 per qualityadjusted life year gained. For children with lumbosacral dimples, who have a higher pretest probability of 3.8%, US was less costly and more effective than the other 3 strategies considered. In intermediate-risk newborns with low anorectal malformation (pretest probability: 27%), US was more effective and less costly than radiographs and no imaging. However, MRI was more effective than US at an incremental cost-effectiveness of $1000 per quality-adjusted life year gained. In the high-risk group that included high anorectal malformation, cloacal malformation, and exstrophy (pretest probability: 44%-46%), MRI was actually cost-saving when compared with the other diagnostic strategies. For the intermediate-risk group, we found our analysis to be sensitive to the costs and diagnostic performances (sensitivity and specificity) of MRI and US. Lower MRI cost or greater MRI diagnostic performance improved the cost-effectiveness of the MRI strategy, whereas lower US cost or greater US diagnostic performance worsened the cost-effectiveness of the MRI strategy. Therefore, individual or institutional expertise with a specific diagnostic modality (MRI versus US) may influence the optimal diagnostic strategy.Conclusion. In newborns with suspected occult dysraphism, appropriate selection of patients and diagnostic strategy may increase quality-adjusted life expectancy and decrease cost of medical work-up. Pediatrics 2001; 108(6). URL: http://www.pediatrics.org/cgi/content/full/ 108/6/e101; cost-effectiveness analysis, occult spinal dysraphism, newborns, MRI, ultrasound.ABBREVIATIONS. MRI, magnetic resonance imaging; QALY, quality-adjusted life year; US, ultrasound; LE, life expectancy. T hree percent of neonates have major central nervous system or systemic malformations. 1 Furthermore, 5% to 15% of pediatric neurology hospital admissions are related to cerebrospinal anomalies. 2 Occult spinal dysraphism (skin-covered lesions with no exposed neural tissue) is the most prevalent spinal axis malformation 3 and the most common indication for spin...

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Change in Spinal Curvature following Release of Tethered Spinal Cord Associated with Spina bif ida

Cited by 78 publications

References 10 publications

The horizontal sacrum as an indicator of the tethered spinal cord in spina bifida aperta and occulta

The horizontal sacrum as an indicator of the tethered spinal cord in spina bifida aperta and occulta

A patient with myelomeningocele: is untethering necessary prior to scoliosis correction?

Newborns With Suspected Occult Spinal Dysraphism: A Cost-Effectiveness Analysis of Diagnostic Strategies

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