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Growth of growth hormone-treated and nontreated children before and after tethered spinal cord release
D Rotenstein1, D H Reigel, J F Lucke
1Section of Pediatric Endocrinology, Medical College of Pennsylvania, Pittsburgh, USA.
Insights
Tethered spinal cord release significantly improved growth rates in children with myelomeningocele (MM). Combining this surgery with recombinant human growth hormone (RHGH) further enhanced growth outcomes compared to surgery alone.
Area of Science:
- Pediatric Endocrinology
- Pediatric Neurosurgery
- Developmental Biology
Background:
- Children with myelomeningocele (MM) often experience short stature and growth impairment.
- A tethered spinal cord, a potential complication after MM closure, can cause neurological and orthopedic issues, potentially affecting growth.
- Recombinant human growth hormone (RHGH) is known to accelerate growth in children.
Purpose of the Study:
- To evaluate the impact of symptomatic tethered spinal cord release (TCR) on the growth rate and length standard deviation score (L-SDS) in prepubertal children with MM.
- To compare the growth response after TCR with an untreated, asymptomatic matched control group.
- To assess the combined effect of TCR and RHGH treatment versus TCR alone in children with MM and growth hormone inadequacy.
Main Methods:
- A cohort of 13 prepubertal children with MM underwent TCR for symptomatic tethered spinal cord.
- Growth rate and L-SDS were measured before and after TCR and compared to a matched control group.
- A subgroup of 7 children with MM and growth hormone inadequacy received both TCR and RHGH, with their outcomes compared to TCR alone.
Main Results:
- TCR significantly increased the growth rate in children with MM compared to matched controls (p < 0.01).
- The combination of TCR and RHGH resulted in a significantly greater gain in growth rate and L-SDS compared to TCR alone (p < 0.01).
- These findings indicate that a tethered spinal cord negatively influences growth in children with MM.
Conclusions:
- Symptomatic tethered spinal cord release positively impacts growth rate in prepubertal children with myelomeningocele.
- Combined treatment with TCR and RHGH offers superior growth benefits over TCR alone for children with MM and growth hormone inadequacy.
- Further research is warranted to elucidate the complex relationship between tethered spinal cord, growth, and therapeutic interventions for growth failure in MM.
Abstract:
Children with myelomeningocele (MM) are very short and respond to treatment with recombinant human growth hormone (RHGH) with an acceleration in growth. Following primary closure of the MM, a tethered spinal cord may produce neurologic and orthopedic deformities. We compared the short-term growth rate and length standard deviation score (L-SDS) for stature of 13 prepubertal children with MM (7 males, 6 females, mean age 6.1 +/- 2.5 years) before and after symptomatic tethered spinal cord release (TCR) to an untreated asymptomatic matched control group. We also compared these data to 7 prepubertal children with MM and growth hormone inadequacy who had TCR and were then treated with RHGH. TCR significantly increased the growth rate compared with matched controls (p < 0.01); however, TCR and RHGH in combination provided an increased gain in growth rate and L-SDS over TCR alone (p < 0.01). Tethered spinal cord influences the growth rate of children with MM. Further study is necessary to evaluate the relationship of the tethered spinal cord to growth and treatment of growth failure.
