Spinal cord ultrasonography in children with myelomeningocele

Abstract

Secondary tethering of the spinal cord in people with myelomeningocele (MMC) is almost universal but there is a relatively low incidence of the secondary tethered cord syndrome (S-TCS). In view of this, we wish to explore the notion that cord pulsation, as demonstrated by ultrasound of the spinal cord, can become an independent measure for increased tension of the spinal cord in patients with MMC. One-hundred and six patients with MMC underwent ultrasonographic examination of their back, a thorough physical examination, and a careful review of their clinical history. Of these patients, 53 had MRI of their back. Cord pulsation was graded and the statistical relation between pulsation and various clinical and MRI findings was analysed. Age and arm span were not correlated with grades of cord pulsation. The absence of cord pulsation correlated with the presence of symptoms but this relation may be explained by MRI findings of certain structural cord malformations and not by tethering per se. Assuming that cord pulsation is a reliable marker for the tension within the spinal cord, the results of our study suggest that overstretching of the cord is not the main cause for the development of the S-TCS.

Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients

“…3,21 Therefore, MR images showing low-lying cord and scarring do not dictate per se a detethering procedure. 21 Magnetic resonance images obtained in the prone position 59 and ultrasonography studies of the spinal cord motion 4 have been proposed to help in the diagnosis of TCS but proved to be of poor practical utility. Accordingly, despite modern imaging progress, the TCS must still be diagnosed mainly on the basis of clinical criteria.…”

Urodynamic Findings in the Tethered Spinal Cord: The Effect of Tethered Cord Division on Lower Urinary Tract Functions*

“…Magnetic resonance imaging is the best radiologic (3,14). Ultrasonography, although it is economical, noninvasive, does not require sedation and is easy to perform, does not yield an optimal image for radiological evaluation of the spinal cord (4,8).…”