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Neurourological implications of the changing approach in management of occult spinal lesions
M A Keating1, R C Rink, S B Bauer
1Department of Neurosurgery, Children's Hospital, Philadelphia, Pennsylvania.
Insights
Occult spinal lesions in children can cause neurogenic dysfunction. Surgical correction may reverse these effects, but reversibility decreases with age, highlighting the importance of early intervention.
Area of Science:
- Pediatric Neurology
- Urology
- Spinal Surgery
Background:
- Occult spinal lesions are rare causes of neurogenic dysfunction in children.
- Dysfunction can affect lower extremities, urinary, and gastrointestinal tracts.
Purpose of the Study:
- To analyze preoperative and postoperative urodynamic findings in children with spinal abnormalities.
- To assess the impact of age on the reversibility of neurourological changes after surgical correction.
Main Methods:
- Urodynamic testing was performed preoperatively and postoperatively in 40 children.
- Patients were divided into two age groups: neonates/infants and older children.
Main Results:
- Preoperative normal urodynamics were more common in younger children (64%) than older children (8%).
- Postoperative improvement was observed in 80% of infants with abnormal preoperative studies.
- Only 27% of older children with abnormal preoperative evaluations normalized postoperatively.
Conclusions:
- Neourological changes from occult spinal lesions are variable, progressive, and age-dependent.
- Surgical correction offers potential reversibility, which is significantly reduced in older children.
- Early diagnosis and surgical intervention are crucial for better outcomes in pediatric spinal abnormalities.
Abstract:
Occult lesions of the spine in children are a rare but recognizable cause of neurogenic dysfunction involving the lower extremities, and lower urinary and gastrointestinal tracts. We report the preoperative and postoperative urodynamic findings in 40 children with varying spinal abnormalities. Of these patients 28 were neonates or infants (average age 8.7 months) and 12 were older children (average age 11.7 years). Preoperative urodynamic testing revealed normal function in 18 of 28 children (64 per cent) in the younger age group in contrast to 1 of 12 (8 per cent) in the older age group. Of the 10 infants with abnormal studies postoperative urodynamic findings returned to normal in 6, while 2 others remained abnormal but were improved. In contrast, of 11 older children with abnormal preoperative evaluations 3 (27 per cent) reverted to normal postoperatively. The neurourological changes seen in these occult lesions are variable, may occur at any age, are progressive and are potentially reversible by surgical correction but this reversibility diminishes with age.