Ultrasonography reveals a high prevalence of lower spinal dysraphism in children with urogenital anomalies

Koo, Bon Nyeo; Hong, Jin Yong; Song, Ho Taek; Kim, J. M.; Kil, Hae Keum

doi:10.1111/j.1399-6576.2011.02612.x

Cited by 26 publications

(19 citation statements)

References 29 publications

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“…36 One study used ultrasound imaging to examine spinal structures and determine the prevalence of spinal dysraphism in children with urogenital anomalies. 34 Children suspected of spinal cord tethering showed a lower level of conus medullaris and thicker filum terminale when compared with the normal group. Evidence suggests that ultrasound imaging enables sufficient visibility of structures accurately enough to detect anatomical variations dependent on body positioning or age, weight, and height.…”

Section: Neuraxial Anesthesiamentioning

confidence: 85%

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Evidence for the Use of Ultrasound Imaging in Pediatric Regional Anesthesia

Lam

Corry

Tsui

2016

Regional Anesthesia and Pain Medicine

110

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Studies in the current review provide stronger evidence and have addressed a number of outcomes that were previously inconsistent or lacked strength in evidence. In the current systematic review, we identified more studies in a shorter period compared with the previous review, and these studies contain higher levels of evidence compared with what we previously found. Randomized controlled trials and well-designed prospective observational studies have replaced case series. Stronger evidence from the literature suggests that ultrasound-guided peripheral blocks decrease block performance time when compared with nerve stimulation (but take longer than the landmark technique), increase block success, and increase block quality (as measured by analgesic consumption, block duration, and pain scores). Ultrasound guidance in neuraxial blocks improves needling time, predicts epidural depth, allows visualization of the catheter and local anesthetic spread, and improves block quality. Furthermore, we identified 2 large-scale prospective studies describing the incidence of adverse events and complications in pediatric regional anesthesia. The increase in evidence presented in this review reflects the efficacy and prevalent use of ultrasound imaging in pediatric regional anesthesia.

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Section: Neuraxial Anesthesiamentioning

confidence: 85%

“…Although neither was significant, these results suggest that pain is managed equally as well with ultrasound-guided blocks, if not better than the traditional gold standard landmark technique, in patients undergoing circumcision. 36 Koo et al, 33,34 Shin et al, 28 Tachibana et al, 29 Ueda et al 39…”

Section: B (Us Vs Landmark Method)mentioning

confidence: 99%

Evidence for the Use of Ultrasound Imaging in Pediatric Regional Anesthesia

Lam

Corry

Tsui

2016

Regional Anesthesia and Pain Medicine

110

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“…8,9 Pediatric studies suggest that children presenting for urologic or general surgical procedures at a young age have an increased incidence of spinal abnormalities, including a low conus medullaris and tethered cord when compared with the general population. 10,11 It has previously been advocated that, because of this association, preoperative spinal imaging should be considered prior to administering a caudal anesthetic to children presenting for these types of procedures at a young age. 10 Our case provides further evidence that supports the use of pre-procedure spinal imaging in neonates and infants who have recently undergone a lumbar puncture and who will be receiving a spinal or caudal anesthetic.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 It has previously been advocated that, because of this association, preoperative spinal imaging should be considered prior to administering a caudal anesthetic to children presenting for these types of procedures at a young age. 10 Our case provides further evidence that supports the use of pre-procedure spinal imaging in neonates and infants who have recently undergone a lumbar puncture and who will be receiving a spinal or caudal anesthetic. Although ultrasonography and fast MRI have some limitations, they could provide important information without the need for general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Failed caudal block due to physiologic changes associated with a cerebrospinal fluid leak: a case report

Bruce

Spencer

Albayram

2016

Can J Anesth/J Can Anesth

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The possible mechanism of this failed caudal block was high systemic absorption of anesthetic given the epidural venous plexus engorgement thus leaving less anesthetic acting within the CSF and on the exiting spinal nerves. Decreased CSF flow in the thecal sac might also have contributed, as might dilution of the remaining local anesthetic caused by large amounts of leaking CSF within the epidural space.

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“…36 Infants in the abnormal group exhibited a consistently lower conus medullaris and thicker filum terminale when compared with healthy infants without anomalies.…”

mentioning

confidence: 89%

Management of urological dysfunction in pediatric patients with spinal dysraphism: review of the literature

Amarante

Shrensel²,

Tomei³

et al. 2012

FOC

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An intact, fully functional spine is the result of a complex sequence of embryological events involving both nervous and musculoskeletal system precursors. Deviations from this highly ordered system can result in congenital abnormalities ranging from clinically insignificant cosmetic changes to CNS malformations that are incompatible with life. Closure of the neural tube, which is believed to be the embryological event gone awry in these cases, is complete by just 28 days' gestation, often before pregnancy is detected. Although progress has been made to help prevent neural tube defects in the children of those attempting to conceive, these congenital deformities unfortunately continue to affect a startling number of infants worldwide each year. Furthermore, the precise mechanisms governing closure of the neural tube and how they might be interrupted remain elusive. What is known is that there are a large number of individuals who must deal with congenital spine dysraphism and the clinical sequelae on a daily basis. Bladder and urinary dysfunction are frequently encountered, and urological care is a critical, often neglected, component in the lifelong multidisciplinary approach to treatment. Although many treatment strategies have been devised, a need remains for evidence-based interventions, analysis of quality of life, and preemptive education of both caregivers and patients as they grow older. Pediatric neurosurgeons in particular have the unique opportunity to address these issues, often in the first few days of life and throughout pre- and postoperative evaluation. With proper management instituted at birth, many patients could potentially delay or avoid the potential urological complications resulting from congenital neurogenic bladder.

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Ultrasonography reveals a high prevalence of lower spinal dysraphism in children with urogenital anomalies

Abstract: The prevalence of OSD in children under 24 months of age with simple urogenital anomaly was higher than what was reported for the general population. Ultrasound examination of spinal structures before caudal block in children with urogenital anomaly should be considered.

Cited by 26 publications

References 29 publications

Evidence for the Use of Ultrasound Imaging in Pediatric Regional Anesthesia

Evidence for the Use of Ultrasound Imaging in Pediatric Regional Anesthesia

Failed caudal block due to physiologic changes associated with a cerebrospinal fluid leak: a case report

Management of urological dysfunction in pediatric patients with spinal dysraphism: review of the literature

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