The patient with symptoms following resection of a lipomyelomeningocele: do increases in the lumbosacral angle indicate a tethered spinal cord?

Tubbs, R. Shane; Naftel, Robert P.; Rice, W.C.; Liechty, Peter; Conklin, Michael; Oakes, W. Jerry

doi:10.3171/ped.2006.105.1.62

Cited by 14 publications

(10 citation statements)

References 12 publications

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“…Additionally, because many pediatric patients may require sedation for MRI, the consideration for obtaining MRI must also include the risk and cost associated with this routine imaging. Tethered cord has been associated with progressive spinal deformities, and a series of 9 patients reported by Tubbs et al 67 noted that tethered cord should be suspected in the presence of symptoms of tethered cord with an increasing lumbosacral angle.…”

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confidence: 99%

Lipomyelomeningocele: pathology, treatment, and outcomes

Sarris

Tomei²,

Carmel³

et al. 2012

FOC

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Lipomyelomeningocele represents a rare but complex neurological disorder that may present with neurological deterioration secondary to an inherent tethered spinal cord. Radiological testing is beneficial in determining the morphology of the malformation. Specialized testing such as urodynamic studies and neurophysiological testing may be beneficial in assessing for neurological dysfunction secondary to the lipomyelomeningocele. Early surgical intervention may be beneficial in preventing further neurological decline.

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confidence: 99%

Lipomyelomeningocele: pathology, treatment, and outcomes

Sarris

Tomei²,

Carmel³

et al. 2012

FOC

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“…The posterior shift of the spinal cord was observed to be insufficient in the kyphotically aligned spine after posterior decompression [14]. Lumbar lordosis increases when symptoms worsen in children with lipomyelomeningocele [6][7][8]. Because the lumbar spine usually has a lordosis, and the lordosis increases in tethered cord syndrome patients, the tethered cord can be shifted to the dorsal side in most cases and can be a treatment option.…”

Section: Discussionmentioning

confidence: 95%

“…Although a few reports have addressed tethered cord syndrome, almost all of the cases were treated surgically by detethering [1][2][3][4][5][6][7][8][9]. Instead of detethering, we performed surgery to reduce the caudal traction force of the tethered cord by opening the lamina and dural sac and shifting the tethered cord to the dorsal side by harnessing the lumbar lordosis.…”

Section: Introductionmentioning

confidence: 97%

Reduction of caudal traction force using dural sac opening rather than spinal cord detethering for tethered cord syndrome caused by lipomyelomeningocele: a case report

Murata¹,

Kanaya²,

Wada³

et al. 2014

The Spine Journal

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“…Tubbs et al [6, 7] retrospectively analyzed the LSA in 30 children with a myelomeningocele and 25 children with a lipomyelomeningocele. They observed that the LSA was often increased for their age.…”

Section: Discussionmentioning

confidence: 99%

The lumbosacral angle does not reflect progressive tethered cord syndrome in children with spinal dysraphism

et al. 2010

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PurposeOur 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.MethodsWe 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.ResultsLSA 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).ConclusionsWe 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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The patient with symptoms following resection of a lipomyelomeningocele: do increases in the lumbosacral angle indicate a tethered spinal cord?

Cited by 14 publications

References 12 publications

Lipomyelomeningocele: pathology, treatment, and outcomes

Lipomyelomeningocele: pathology, treatment, and outcomes

Reduction of caudal traction force using dural sac opening rather than spinal cord detethering for tethered cord syndrome caused by lipomyelomeningocele: a case report

The lumbosacral angle does not reflect progressive tethered cord syndrome in children with spinal dysraphism

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