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Tethered cord syndrome in children with anorectal malformations
N Muthukumar1, B Subramaniam, T Gnanaseelan
1Department of Neurosurgery, Madurai Medical College, India. natmuthu@vsnl.com
Insights
Children with anorectal malformations often have sacral abnormalities and neurological deficits. Early screening for correctable intraspinal lesions is recommended to improve outcomes.
Area of Science:
- Pediatric Surgery
- Neurology
- Radiology
Background:
- Anorectal malformations (ARMs) are frequently associated with neurological deficits.
- These deficits can significantly contribute to patient disability.
- Understanding associated spinal abnormalities is crucial for comprehensive patient care.
Purpose of the Study:
- To determine the incidence and pattern of sacral abnormalities in children with ARMs.
- To assess the incidence and nature of neurological deficits in this population.
- To identify the occurrence and characteristics of operable intraspinal abnormalities.
Main Methods:
- Neurological evaluation of 81 children with ARMs.
- Plain X-ray films for sacral abnormality assessment.
- Evaluation for operable intraspinal anomalies in patients with neurological deficits.
Main Results:
- 21% of children showed radiographic evidence of sacral abnormalities.
- 15% of patients presented with neurological deficits.
- 10% had operable intraspinal anomalies, including one case of split notochord syndrome.
Conclusions:
- Sacral bone abnormalities, neurological deficits, and operable intraspinal lesions are common in children with ARMs.
- Early identification and treatment of correctable intraspinal lesions are vital.
- Routine screening is recommended for patients with ARMs and neurological deficits or sacral abnormalities.
Object:
Anorectal malformations are known to be associated with neurological deficits, which may contribute to the disability suffered by patients with these malformations. This study was undertaken to determine the incidence and pattern of sacral abnormalities in children with anorectal malformations, the incidence and nature of the neurological deficits, and the incidence and nature of operable intraspinal abnormalities in patients with this condition.
Methods:
Neurological evaluation was performed in 81 children with anorectal malformations. Plain x-ray films were obtained to identify the presence of sacral abnormalities. The patients with neurological deficits were evaluated for the presence of operable intraspinal anomalies, and when such anomalies were identified, correction of the same was undertaken. In 21% of these children radiographic evidence of sacral abnormalities was shown. Fifteen percent of patients harbored neurological deficits, and 10% harbored operable intraspinal anomalies. In addition, one patient had split notochord syndrome. Patients with operable intraspinal anomalies underwent surgical correction, with resultant neurological improvement.
Conclusions:
Bone abnormalities of the sacrum, neurological deficits, and operable intraspinal lesions are not uncommon in children with anorectal malformations. Because the neurological deficits can contribute to the disability suffered by these individuals, we recommend routine screening of patients with anorectal malformations and neurological deficits and/or sacral abnormalities for the early identification and treatment of potentially correctable intraspinal lesions.