Neuroradiologic evaluation of sacral abnormalities in imperforate anus complex

Area of Science:

• Pediatric Surgery
• Neurology
• Radiology

Background:

• Neurologic impairment and sacral spinal anomalies are common in children with imperforate anus.
• Previously, these neurologic deficits were considered static, but recent observations suggest progressive dysfunction in some cases.

Purpose of the Study:

• To investigate the nature and frequency of spinal cord anomalies in patients with imperforate anus.
• To determine if progressive neurologic dysfunction in these patients is potentially correctable through neurosurgical intervention.

Main Methods:

• Screening of 106 imperforate anus patients with sacral spine radiographs; 37 (35%) showed abnormalities.
• 26 patients with abnormalities underwent spinal cord imaging, including MRI, CT, and myelography.
• Evaluation of 15 patients (53%) with abnormal imaging studies for progressive dysfunction and potential neurosurgical correction.

Main Results:

• Fifteen of 26 evaluated patients (53%) had abnormal spinal cord imaging studies.
• Thirteen patients with progressive dysfunction and operable lesions underwent neurosurgery.
• Post-surgery, five patients showed improved leg function and two showed improved bladder function, with no new deficits.

Conclusions:

• A high incidence of progressive, potentially correctable myelodysplasias exists in patients with anorectal and sacral anomalies.
• Routine radiographic screening of the spine is recommended for imperforate anus patients.
• Spinal cord imaging and neurosurgical evaluation are warranted for patients with suspected progressive neurologic dysfunction.