The Neurosurgical Implications of Continuous Neurourological Surveillance of Children with Myelodysplasia

Lais, Alberto; Kasabian, Nabet G.; Dyro, Frances M.; Scott, R. Michael; Kelly, Mary; Bauer, Stuart B.

doi:10.1016/s0022-5347(17)35922-0

Cited by 62 publications

(22 citation statements)

References 17 publications

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“…Indeed, although these criteria may reflect genuine neurogenic dysfunction, they may also represent functional disorders or be part of the normal maturation process of voiding. [10][11][12]18,24,34,38 Urologically, patients were clinically stabilized or improved in 64% of the cases in our study. This is in agreement with recommendations found in current literature, which suggest that early untethering prevents bladder deterioration and the occurrence of neurological deficits and orthopedic deformities at a later age.…”

Section: Discussionsupporting

confidence: 53%

“…7,13,22,32,45 This apparent discrepancy is easily explained by the fact that our Group 1 population was younger that the ones reported in these studies. 6,8,14,18,19,22,24,35 In addition, untethering is believed by some to prevent the possibility of sudden neurourological deterioration following trivial spinal trauma. In fact, in two papers in which the age of patients with occult spinal dysraphism was specifically addressed, urological symptoms were either absent or rare in patients younger than 1.5 years, whereas findings of urodynamic studies proved abnormal in 36% and 58% of cases.…”

Section: Discussionmentioning

confidence: 99%

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Impact of urodynamic studies on the surgical management of spinal cord tethering

Vernet¹,

Farmer²,

Houle³

et al. 1996

Journal of Neurosurgery

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To determine the usefulness of urodynamic studies in the management of children with a suspected tethered spinal cord, the authors retrospectively reviewed case records of 25 patients evaluated both pre- and postoperatively using this diagnostic adjunct. All patients were also evaluated with magnetic resonance imaging or computerized tomography myelography. Seven patients who presented initially with orthopedic deformity, skin stigmata, and neurological problems underwent primary cord untethering (Group 1). All seven patients were urologically asymptomatic; all but one had normal findings on urodynamic study. Eighteen patients with prior myelomeningocele closure underwent secondary untethering (Group 2). They presented with urological (11 cases), neurological (three cases), or both urological and neurological (four cases) deterioration. All patients underwent surgery via a microsurgical technique. At a mean follow-up time of 2 years, the only Group 1 patient with preoperative abnormal urodynamic findings normalized following untethering, whereas another asymptomatic patient showed worsened results on his postoperative study. In Group 2, all seven patients with preoperative neurological deterioration improved. Ten of the 15 patients who had isolated or associated preoperative clinical urological deterioration improved or stabilized, whereas five displayed continued deterioration in their bladder function. With respect to urodynamic studies, there was a significant increase in total and pressure-specific bladder capacities following untethering. We conclude that urodynamic studies are useful both diagnostically and in follow-up examinations of patients with tethered cord, that disturbances identified by these studies often precede clinical manifestations of deterioration, and that spinal cord untethering favorably influences the urological status in most patients.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Impact of urodynamic studies on the surgical management of spinal cord tethering

Vernet¹,

Farmer²,

Houle³

et al. 1996

Journal of Neurosurgery

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“…Lais et al followed 148 children with myelomeningocele and 40% showed evidence of deterioration during the first two years of life when growth is at its most rapid 24. Some studies of “occult” spinal defects are misleading, in that they suggest a significant chance of stability and even improvement in some cases 6…”

Section: Discussionmentioning

confidence: 99%

Bladder dysfunction and neurological disability at presentation in closed spina bifida

Johnston

Borzyskowski

1998

Archives of Disease in Childhood

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Congenital closed spinal anomalies are associated with distortion of the spinal cord, the spinal nerve roots or both, and can result in neurological abnormalities of the lower limbs and neuropathic bladder dysfunction. This study reports clinical and videourodynamic findings in a group of 51 patients with closed spina bifida. The mean age at presentation to a specialist neurourological clinic was 3.3 years. Twenty five patients presented with urinary tract disturbance and 12 presented with neurological problems. Thirty three had normal neurological examination or only minor objective signs, 21 had normal renal tract ultrasonography but only two patients had normal videourodynamics, with 31 having two or more abnormalities during this assessment. Neither clinical neurological assessment nor the history of voiding behaviour are reliable indicators of bladder dysfunction and subsequent risk of renal damage. Therefore, all patients with a known or suspected diagnosis of closed spina bifida should have videourodynamic assessment.

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“…There is increasing evidence that supports the fact that patients with primary tethered cord will sooner or later develop or experience worsening of neurological deficits if they do not undergo spinal cord untethering [5,6,7,8,9]. Better postoperative outcomes have been reported when this condition is repaired promptly after the appearance of deficits [10,11,12,13]. Early detection of individuals who are at risk of further deterioration is of paramount importance.…”

Section: Discussionmentioning

confidence: 99%

Primary Tethered Cord Syndrome - Clinical and Urological Manifestations, Diagnosis and Management: A Prospective Study

Ailawadhi

Kale²,

Agrawal³

et al. 2012

Pediatr Neurosurg

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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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The Neurosurgical Implications of Continuous Neurourological Surveillance of Children with Myelodysplasia

Cited by 62 publications

References 17 publications

Impact of urodynamic studies on the surgical management of spinal cord tethering

Impact of urodynamic studies on the surgical management of spinal cord tethering

Bladder dysfunction and neurological disability at presentation in closed spina bifida

Primary Tethered Cord Syndrome - Clinical and Urological Manifestations, Diagnosis and Management: A Prospective Study

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