Low-lying spinal cord and tethered cord syndrome in children with anorectal malformations

Area of Science:

• Pediatric Surgery
• Neuroscience
• Radiology

Background:

• Anorectal malformations (ARMs) and low-lying spinal cord (LLC) share a common embryonic origin, frequently co-occurring in pediatric patients.
• LLC can lead to tethered cord syndrome (TCS), a condition often necessitating surgical intervention.
• Understanding the incidence and outcomes of LLC in ARM patients is crucial for effective management.

Purpose of the Study:

• To determine the incidence of LLC in children diagnosed with ARM using ultrasonography (US) and magnetic resonance (MR) imaging.
• To review the incidence of TCS in this cohort and evaluate surgical outcomes following detethering procedures.
• To assess the diagnostic utility of US and MR imaging in identifying LLC in ARM patients.

Main Methods:

• A retrospective study was conducted on pediatric patients who underwent surgery for ARM between 2002 and 2009.
• Data collected included imaging findings (US and MR) and outcomes of surgical detethering for LLC and TCS.
• Incidence rates of LLC and TCS were analyzed in relation to ARM type and imaging results.

Main Results:

• Out of 101 ARM patients, 17 (16.8%) were diagnosed with LLC, predominantly in high ARM cases (12/17).
• Abnormal findings on US and MR imaging were present in 12 of the 17 LLC patients; 5 had normal US but abnormal MR.
• Seventeen patients underwent surgical detethering; 3 of 7 with TCS showed improvement, with no reported complications.

Conclusions:

• LLC is associated with ARM, particularly high types, warranting investigation regardless of ARM classification.
• Lumbar US serves as an effective first-line screening tool for LLC; MR imaging is recommended for equivocal US findings or new symptoms.
• Surgical detethering can improve outcomes for TCS, and prophylactic detethering in asymptomatic lipoma of the filum terminale carries low surgical risk.