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Published on: April 17, 2019
Routine MRI evaluation of low imperforate anus reveals unexpected high incidence of tethered spinal cord
Naomi R Golonka1, Linda J Haga, Robert P Keating
1Department of Pediatric Surgery, Children's National Medical Center, Washington, DC 20010, USA.
Insights
Children with imperforate anus, including those with low lesions, have a significant incidence of tethered cord. Early magnetic resonance imaging (MRI) evaluation for tethered cord is recommended for all infants with imperforate anus.
Area of Science:
- Pediatric Surgery
- Neuroscience
- Medical Imaging
Background:
- Imperforate anus is a congenital anomaly often associated with other conditions.
- Tethered cord is a known complication, typically evaluated in high-lesion cases.
- The incidence in low-lesion imperforate anus requires further definition.
Purpose of the Study:
- To determine the incidence of tethered cord in children with low imperforate anus lesions.
- To compare tethered cord incidence between high and low imperforate anus lesions.
- To evaluate the utility of routine magnetic resonance imaging (MRI) for tethered cord detection.
Main Methods:
- Retrospective review of 63 children with imperforate anus over 13 years.
- Lesion categorization as high (supralevator) or low (infralevator).
- Routine magnetic resonance imaging (MRI) for tethered cord evaluation.
Main Results:
- 22 out of 63 patients (34.9%) had a tethered cord.
- Incidence was 26.8% in high lesions and 50.0% in low lesions.
- 83% of boys and 38% of girls with low lesions had tethered cord; 45% had no other lumbosacral anomalies.
Conclusions:
- The incidence of tethered cord in low-lesion imperforate anus is similar to high-lesion cases.
- Routine MRI for tethered cord evaluation is advocated for all imperforate anus patients.
- Early detection and surgical release of tethered cord are crucial.
Background/Purpose:
Previous clinical practice has included evaluation for the presence of tethered cord in those children who have imperforate anus with a high lesion. To define the incidence in children with low lesions, the authors reviewed their experience with a protocol employing routine magnetic resonance imaging (MRI), regardless of the level of the lesion, to determine the presence of a tethered cord in all children with imperforate anus.
Methods:
A retrospective review of children with imperforate anus was conducted over the last 13 years at our institution. Lesions were categorized as high versus low based on the supralevator or infralevator position of the fistula.
Results:
Sixty-three patients completed evaluation for a tethered cord. Twenty-two (34.9%) of these 63 patients had a tethered cord: 11 of 41 (26.8%) patients with high lesions and 11 of 22 (50.0%) of those with low lesions. Of those children with a low lesion, 83% of the boys had a tethered cord, whereas 38% of the girls had a tethered cord. Forty-five percent of the patients with low lesions and a tethered cord did not have any other lumbosacral anomalies. All 22 children with a tethered cord underwent surgical release.
Conclusions:
The incidence of tethered cord in children with low lesions of imperforate anus is not lower than those with high lesions. The authors advocate early evaluation of all children with imperforate anus for a tethered cord.
