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Johari AN, Nemade A, Dhawale A, Wadia F, Shah M. Spinal dysraphism in congenital scoliosis and kyphosis: a retrospective analysis in an Indian population. INTERNATIONAL ORTHOPAEDICS 2024; 48:1589-1598. [PMID: 38581468 DOI: 10.1007/s00264-024-06156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Early recognition is crucial for occult spinal dysraphism associated with congenital spinal deformities. There is limited literature available on its occurrence in congenital scoliosis and kyphosis in the Indian population. METHODS Our study involved a retrospective review of 247 children who presented at a single centre. We analyzed their demographics and clinical and radiological findings, which included the type of deformity, its location, vertebral anomaly, Cobb angle, and MRI findings. The deformities were categorized as congenital scoliosis or congenital kyphosis with failure of formation, failure of segmentation, or both. RESULTS A total of 247 cases were examined (congenital scoliosis-229, congenital kyphosis-18). The average age was seven years (range 0.8 to 19 years, SD 4.6). The mean Cobb angle at presentation in the congenital scoliosis group was 49.4° (range 8 to 145°, SD 23.77) for those with abnormal MRI and 42.45° (range 5 to 97°, SD 20.09) for those with normal MRI. For the congenital kyphosis group, the mean K angle at presentation was 47.7° (range 14 to 110°, SD 33.33) for those with abnormal MRI and 47.36° (range 15 to 70°, SD 16.63) for those with normal MRI. Abnormal MRI results were observed in 130 of the patients (congenital scoliosis-53.7%, congenital kyphosis-38.8%). The highest incidence of abnormal MRI findings was observed in the failure of segmentation (66.6%) and mixed (65%) types. Deformities in the dorsal region had the highest incidence (61.9%). The most common dysraphism instances were diastematomyelia and tethered cord. There was a significant correlation between type of deformity and presence of dysraphism. CONCLUSION This is the largest case series of congenital scoliosis and kyphosis reported from India. We found a high incidence of occult spinal dysraphism as compared to other published series. Occult spinal dysraphism is more common in the thoracic region. Diastematomyelia followed by tethered cord was the most common anomaly observed. We recommend MRI screening of whole spine and craniovertebral junction.
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Affiliation(s)
| | - Amit Nemade
- Department of Orthopedics, N K P Salve Institute of Medical Sciences & Research Centre, Nagpur, India
| | - Arjun Dhawale
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital and B.J. Wadia Hospital for Children, Mumbai, India.
| | - Farokh Wadia
- Southampton Children's Hospital, Southampton, UK
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Bulahs I, Teivāne A, Platkājis A, Balodis A. Caudal Regression Syndrome First Diagnosed in Adulthood: A Case Report and a Review of the Literature. Diagnostics (Basel) 2024; 14:1000. [PMID: 38786298 PMCID: PMC11119840 DOI: 10.3390/diagnostics14101000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Caudal regression syndrome (CRS) is a rare congenital malformation characterized by incomplete development of the lower spine and spinal cord. Its estimated incidence ranges from 1 to 2 per 100,000 live births, leading to a spectrum of clinical presentations. Although most cases are diagnosed during childhood, only a small number of cases have been documented in adults in the medical literature. Case Report: A 27-year-old woman underwent an outpatient magnetic resonance imaging (MRI) of the thoracolumbar spine due to severe lower back pain experienced for the first time. Despite congenital leg abnormalities and multiple childhood surgeries, no further investigations were conducted at that time. MRI revealed congenital anomalies consistent with CRS, including coccygeal agenesis, L5 sacralization, and spinal cord defects. The patient also had a long-standing pilonidal cyst treated conservatively, now requiring operative treatment due to an abscess. Conclusions: This report underscores a rare case of CRS initially misdiagnosed and mistreated over many years. It emphasizes the importance of considering less common diagnoses, especially when initial investigations yield inconclusive results. This clinical case demonstrates a highly valuable and educative radiological finding. In the literature, such cases with radiological findings in adults are still lacking.
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Affiliation(s)
- Intars Bulahs
- Faculty of Residency, Riga Stradins University, 1007 Riga, Latvia (A.T.)
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia
| | - Agnete Teivāne
- Faculty of Residency, Riga Stradins University, 1007 Riga, Latvia (A.T.)
- Department of Neurology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia
| | - Ardis Platkājis
- Department of Radiology, Riga Stradins University, 1007 Riga, Latvia;
| | - Arturs Balodis
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia
- Department of Radiology, Riga Stradins University, 1007 Riga, Latvia;
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Balani A, Sidpra J, Sudhakar S, Biswas A, Öztekin Ö, Capra V, Catala M, Copp AJ, Kumar N, Johal N, Tahir MZ, Thompson D, Pang D, Mirsky DM, Ho ML, Huisman TAGM, Rossi A, Mankad K. International Consensus Statement on the Radiological Evaluation of Dysraphic Malformations of the Spine and Spinal Cord. AJNR Am J Neuroradiol 2024:ajnr.A8117. [PMID: 38360788 DOI: 10.3174/ajnr.a8117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/13/2023] [Indexed: 02/17/2024]
Abstract
Dysraphic malformations of the spine and spinal cord (DMSSC) represent a spectrum of common congenital anomalies typically (though not exclusively) affecting the lower spinal segments. These may be responsible for varying degrees of neurologic, orthopedic, and urologic morbidity. With advances in neuroimaging, it is now possible to better diagnose and evaluate these disorders both prenatally and postnatally. Neuroimaging, performed at the right time and with technique optimization, is integral in guiding clinical management. However, the terminology used to describe these lesions has become increasingly confusing, and there is a lack of consensus regarding the essential radiologic features and their clinical weighting. This variability in radiologic practice risks unstructured decision making and increases the likelihood of suboptimal, less informed clinical management. In this manuscript, the first of a series of consensus statements, we outline a standardized international consensus statement for the radiologic evaluation of children with suspected DMSSC derived from a critical review of the literature, and the collective clinical experience of a multinational group of experts. We provide recommendations for plain radiography, sonography, CT, and MR imaging in the evaluation of DMSSC with an emphasis on technique of imaging and imaging protocols.
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Affiliation(s)
- Ankit Balani
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jai Sidpra
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - Sniya Sudhakar
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Asthik Biswas
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Özgür Öztekin
- Department of Neuroradiology (Ö.Ö.), Izmir Bakircay University, Izmir, Turkey
| | - Valeria Capra
- Medical Genetics Unit (V.C.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martin Catala
- Laboratoire de Biologie du Développement (M.C.), UMR 7622 de Sorbonne Université et du CNRS, ERL 1156 de l'INSERM et Institut de Biologie Paris Seine, Paris, France
| | - Andrew J Copp
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neetu Kumar
- Department of Urology (N.K., N.J.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Navroop Johal
- Department of Urology (N.K., N.J.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Zubair Tahir
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dominic Thompson
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dachling Pang
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Department of Paediatric Neurosurgery (D.P.), University of California, Davis, Davis, California
| | - David M Mirsky
- Department of Radiology (D.M.M.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Mai-Lan Ho
- Department of Radiology (M.-L.H.), Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology (T.A.G.M.H.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Andrea Rossi
- Neuroradiology Unit (A.R.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (A.R.), University of Genoa, Genoa, Italy
| | - Kshitij Mankad
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
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Kerensky MJ, Paul A, Routkevitch D, Hersh AM, Kempski Leadingham KM, Davidar AD, Judy BF, Punnoose J, Williams A, Kumar A, Lehner K, Smith B, Son JK, Azadi JR, Shekhar H, Mercado-Shekhar KP, Thakor NV, Theodore N, Manbachi A. Tethered spinal cord tension assessed via ultrasound elastography in computational and intraoperative human studies. COMMUNICATIONS MEDICINE 2024; 4:4. [PMID: 38182729 PMCID: PMC10770351 DOI: 10.1038/s43856-023-00430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Tension in the spinal cord is a trademark of tethered cord syndrome. Unfortunately, existing tests cannot quantify tension across the bulk of the cord, making the diagnostic evaluation of stretch ambiguous. A potential non-destructive metric for spinal cord tension is ultrasound-derived shear wave velocity (SWV). The velocity is sensitive to tissue elasticity and boundary conditions including strain. We use the term Ultrasound Tensography to describe the acoustic evaluation of tension with SWV. METHODS Our solution Tethered cord Assessment with Ultrasound Tensography (TAUT) was utilized in three sub-studies: finite element simulations, a cadaveric benchtop validation, and a neurosurgical case series. The simulation computed SWV for given tensile forces. The cadaveric model with induced tension validated the SWV-tension relationship. Lastly, SWV was measured intraoperatively in patients diagnosed with tethered cords who underwent treatment (spinal column shortening). The surgery alleviates tension by decreasing the vertebral column length. RESULTS Here we observe a strong linear relationship between tension and squared SWV across the preclinical sub-studies. Higher tension induces faster shear waves in the simulation (R2 = 0.984) and cadaveric (R2 = 0.951) models. The SWV decreases in all neurosurgical procedures (p < 0.001). Moreover, TAUT has a c-statistic of 0.962 (0.92-1.00), detecting all tethered cords. CONCLUSIONS This study presents a physical, clinical metric of spinal cord tension. Strong agreement among computational, cadaveric, and clinical studies demonstrates the utility of ultrasound-induced SWV for quantitative intraoperative feedback. This technology is positioned to enhance tethered cord diagnosis, treatment, and postoperative monitoring as it differentiates stretched from healthy cords.
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Affiliation(s)
- Max J Kerensky
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abhijit Paul
- Discipline of Biological Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Denis Routkevitch
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew M Hersh
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelley M Kempski Leadingham
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Daniel Davidar
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joshua Punnoose
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Autumn Williams
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avisha Kumar
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kurt Lehner
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Beth Smith
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer K Son
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javad R Azadi
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Himanshu Shekhar
- Discipline of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Karla P Mercado-Shekhar
- Discipline of Biological Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amir Manbachi
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA.
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Finazzi Agrò E, Rosato E, Wagg A, Sinha S, Fede Spicchiale C, Serati M, Mancini V, de Rijk M, Tarcan T, Wein A, Abrams P, Bou Kheir G. How do we make progress in phenotyping patients with LUT such as OAB and underactive detrusor, including using urine markers and microbiome data, in order to personalize therapy? ICI-RS 2023: Part 1. Neurourol Urodyn 2024. [PMID: 38178627 DOI: 10.1002/nau.25377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction. OBJECTIVES The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment. METHODS A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment. RESULTS AND CONCLUSIONS The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract symptoms, such as OAB and UAB. The intricate interplay between the lower urinary tract and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Rosato
- School of specialization in Urology, Policlinico Tor Vergata University Hospital, University of Rome Tor Vergata and Urology Unit, Rome, Italy
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | - Maurizio Serati
- Department Obstetrics and Gynecology, Urogynecology Unit, University of Insubria, Varese, Italy
| | - Vito Mancini
- Urology and renal transplantation Unit, Urinary incontinence center, Policlinico di Foggia Hospital and University of Foggia, Foggia, Italy
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Tufan Tarcan
- Marmara University School of Medicine, Istanbul, Turkey and Koç University School of Medicine, Istanbul, Turkey
| | - Alan Wein
- University of Miami Miller School of Medicine, Desai Sethi Institute of Urology, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Aoki H, Mugikura S, Shirane R, Hayashi T, Kimiwada T, Sakai K, Ainoya K, Ota H, Takase K, Shimanuki Y. Role of Magnetic Resonance Imaging in the Screening of Closed Spinal Dysraphism. Neurol Med Chir (Tokyo) 2023; 63:473-481. [PMID: 37648539 PMCID: PMC10687668 DOI: 10.2176/jns-nmc.2023-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/14/2023] [Indexed: 09/01/2023] Open
Abstract
Closed spinal dysraphism (CSD) encompasses a heterogeneous group of spinal cord deformities, which can be accompanied by several types of skin stigmata. These skin stigmata may include inconspicuous features, such as sacral dimples and deformed gluteal clefts, but the association between such mild skin stigmata and CSD is uncertain. This study aimed to reevaluate the indication for magnetic resonance imaging (MRI) in patients with skin stigmata while considering the indication for surgery. A retrospective analysis was conducted on magnetic resonance images of 1255 asymptomatic children with skin stigmata between 2003 and 2015. Skin stigmata classification was based on medical chart data. All subtypes of CSDs except for filum terminale lipomas (FTL), FTL thicker than 2 mm or with low conus medullaris, were considered to meet the surgical indication. CSD prevalence was estimated while considering the surgical indications and assessed after excluding all FTL cases. Skin stigmata were classified into seven types, dimple, deformed gluteal cleft, hair, subcutaneous mass, appendage, discoloration, and protruding bone, and included 1056 isolated and 199 complex ones. The prevalence of CSD was 19.5%, 6.8%, and 0.5% among patients with isolated dimples (n = 881) and 13.9%, 5.8%, and 0.7% among those with isolated deformed gluteal clefts (n = 136) for all cases, surgical indications, and patients without FTL, respectively. Dimples and deformed gluteal clefts had a low prevalence of CSD requiring surgical intervention, and cases without FTL were rare. Asymptomatic patients with mild skin stigmata may not require immediate MRI.
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Affiliation(s)
- Hidekazu Aoki
- Department of Radiology, Miyagi Children's Hospital
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Reizo Shirane
- Department of Neurosurgery, Miyagi Children's Hospital
| | | | | | | | - Keiko Ainoya
- Department of Urology, Miyagi Children's Hospital
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital
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Otto N, Kucera J, Hayes LL, Chandra T. Tethered Cord Syndrome: Role of Imaging Findings in Surgical Decision-Making. Cureus 2023; 15:e44854. [PMID: 37809232 PMCID: PMC10560071 DOI: 10.7759/cureus.44854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
For infants presenting with urinary problems or lower extremity weakness, imaging is ordered to investigate spinal pathology. Tethered cord syndrome (TCS) often manifests without conclusive anatomic evidence. In our case, a premature infant presented with urosepsis and was found to have an asymmetric gluteal crease and a sacral dimple. Renal ultrasound showed mild hydronephrosis, and a cystourethrogram revealed bilateral high-grade vesicoureteral reflux. Ultrasound and magnetic resonance imaging demonstrated a borderline low-lying spinal cord at the mid-L3 vertebral level. Urodynamic testing to confirm neurogenic bladder could not be completed on the first attempt due to urinary tract infection and on the second attempt due to instrument intolerance. Despite the lack of conclusive imaging evidence of a tethered cord, enough supportive clinical data was present to proceed with surgical intervention with the goal of preventing the progression of neurological dysfunction. Because TCS is ultimately a clinical diagnosis, appropriate management should not be discouraged by inconclusive or borderline imaging findings.
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Affiliation(s)
- Nolan Otto
- Radiology, University of Central Florida, College of Medicine, Orlando, USA
| | - Jennifer Kucera
- Pediatric Radiology, Nemours Children's Hospital, Orlando, USA
| | - Laura L Hayes
- Pediatric Radiology, Nemours Children's Hospital, Orlando, USA
| | - Tushar Chandra
- Pediatric Radiology, Nemours Children's Hospital, Orlando, USA
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Hunsaker P, Gupta K, Otto N, Epelman MJ, Chandra T. Developmental Abnormalities of the Pediatric Spine: A Review of the Correlation Between Ultrasound and MRI Findings. Cureus 2023; 15:e44580. [PMID: 37790066 PMCID: PMC10545393 DOI: 10.7759/cureus.44580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 10/05/2023] Open
Abstract
A broad spectrum of spinal pathologies can affect the pediatric population. Ultrasound (US) is the primary modality for pediatric spine assessment due to its widespread availability, non-requirement of sedation, and absence of ionizing radiation. Supplementing this, MRI offers an in-depth exploration of these conditions, aiding in preoperative strategizing. In this review, we examine the clinical indications, methodologies, and protocols for US and MRI scans of the pediatric spine. Additionally, we illustrate normal pediatric spinal anatomy, highlighting several examples of normal variants that are often misinterpreted. Through a series of case-based illustrations, we offer a comprehensive overview of various pathological conditions such as tethered cord, spinal dysraphism, spinal lipoma, diastematomyelia, and dermal sinus tract, among others. Furthermore, we explore the correlation between US and MRI findings for these lesions, employing real-world cases to enhance our understanding of this topic.
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Affiliation(s)
- Parker Hunsaker
- Diagnostic Radiology, University of Central Florida College of Medicine, Orlando, USA
| | - Kanika Gupta
- Diagnostic Radiology, University of Arizona, Tucson, USA
| | - Nolan Otto
- Diagnostic Radiology, University of South Florida Health, Orlando, USA
| | | | - Tushar Chandra
- Pediatric Radiology, Nemours Children's Hospital, Orlando, USA
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9
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Reyes-Hadsall S, Park L, Frauenfelder A, Fayiga FF, Graneiro A, Duarte AM. Concerning Newborn Rashes and Developmental Abnormalities: Part I: Common and Benign Findings. Pediatr Rev 2023; 44:426-446. [PMID: 37525308 DOI: 10.1542/pir.2022-005726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Sophia Reyes-Hadsall
- University of Miami Miller School of Medicine, Miami, FL
- Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
| | - Lily Park
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Nova Southeastern University, Fort Lauderdale, FL
| | | | - Folasade F Fayiga
- University of Miami Miller School of Medicine, Miami, FL
- Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
- Wright State University Boonshoft School of Medicine, Fairborn, OH
| | - Ana Graneiro
- Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
| | - Ana M Duarte
- Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Nova Southeastern University, Fort Lauderdale, FL
- Children's Skin Center, Miami, FL
- Florida International University, Miami, FL
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10
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Nevus Simplex. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2023. [DOI: 10.1097/jdn.0000000000000730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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11
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Malhotra AK, Shakil H, Wilson JR. Chronic Hydrocephalus and Tethered Cord Masquerading as Postconcussive Syndrome. World Neurosurg 2023; 171:145-147. [PMID: 36649856 DOI: 10.1016/j.wneu.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/16/2023]
Abstract
We present a rare case of chronic hydrocephalus and tethered cord syndrome in a high-functioning asymptomatic college student. Her presentation was triggered by a fall, at which time, she developed subacute symptoms consistent with progressive increased intracranial pressure. After endoscopic third ventriculostomy for hydrocephalus, the patient presented with progressive bilateral lower extremity and sphincter symptoms, leading to spinal imaging and diagnosis of tethered cord syndrome with fatty filum. The patient was treated with tethered cord release and had a favorable long-term outcome. This case highlights the innocuous onset of 2 congenital diagnoses in adulthood seemingly associated with a mild traumatic injury. Furthermore, it shows classic imaging findings associated with chronic increased intracranial pressure, aqueductal stenosis, and tethered cord syndrome (preoperative and postoperative appearances), which serve an important educational role given the relate rarity of these coexisting diseases in adults.
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Affiliation(s)
- Armaan K Malhotra
- Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Husain Shakil
- Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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12
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Hung JW, Chow JS, Kuok MC, Lam AK, Lee JL, Yam FS, Chung KL, Wu SP, Cheung FC, Chan WK, Leung MW. Correlation of urodynamic studies and somatosensory evoked potential and their prognostic value in children with closed spinal dysraphism. J Pediatr Urol 2022; 19:193.e1-193.e8. [PMID: 36566130 DOI: 10.1016/j.jpurol.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Somatosensory evoked potential (SSEP) and urodynamic studies (UD) are valuable tools for assessing patients with closed spinal dysraphism (CSD) before neurosurgical intervention. No studies have correlated their findings in this cohort and our aim is to study their correlation and prognostic value in pediatric patients with closed spinal dysraphism. METHODS Retrospective review of all patients referred to a multidisciplinary clinic in a tertiary pediatric surgical center over a 17 years period between April 2004 to September 2021 was performed. Inclusion criteria were <18 years old, diagnosed with CSD, with SSEP and UD done within 1 year of each other. Demographics data collected include age at presentation/at referral/at neurosurgical operation, gender, symptoms at presentation and intra-operative diagnoses. Pre-operative SSEP and UD findings were documented. Primary outcome was UD results in the group with normal and abnormal SSEP. Secondary outcome was urological and bowel function outcome in 4 groups of patients (Group A-both normal SSEP and UD, Group B- abnormal SSEP only, Group C - abnormal UD only and Group D-both abnormal SSEP and UD). RESULTS A total of 45 patients were included for analysis. Mean follow up time was 118.9 months (24-216 months, SD 55.8 months). SSEP was normal in 20 patients and abnormal in 25 patients. Baseline demographics, preoperative symptoms and imaging were similar between 2 groups. Primary outcome Patients with abnormal SSEP were more likely to have abnormal UD results with a statistically significant difference (84% vs 40%, p < 0.05). They have a significantly higher end-fill detrusor pressure (12% vs 0%, p < 0.05), abnormal bladder compliance (20% vs 0%, p < 0.05), abnormal cystometric capacity (48% vs 10%, p < 0.05), poor emptying efficiency (24% vs 5%, p < 0.05) and sphincter incompetence (8% vs 0%, p < 0.05). Secondary outcome When compared to Groups A to C, patients in group D were more likely to be on anti-cholinergic (33.3% vs 4.3%, p < 0.05), required clean intermittent catheterization (42.9% vs 4.3%, p < 0.05) and had intravesical botulinum injection (19% vs 0%, p < 0.05). All the patients who had augmentation cystoplasty were in this group as well. Bowel function in terms of regular enema use was also statistically significantly higher in this group (33.4% p < 0.05). CONCLUSION Pre-operative SSEP and UD results correlate well in patients with closed spinal dysraphism. Patients with abnormal SSEP and UD preoperatively have higher risk of urological deterioration over time. Close monitoring in this group is warranted.
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Affiliation(s)
- Judy Ws Hung
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong.
| | - Joyce Sw Chow
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong
| | - Manson Ci Kuok
- Department of Paediatrics and Adolescent Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Alva Kf Lam
- Department of Paediatrics and Adolescent Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Joseph Ly Lee
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong
| | - Felix Sd Yam
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong
| | | | - Shun Ping Wu
- Department of Paediatrics and Adolescent Medicine, Queen Elizabeth Hospital, Hong Kong
| | | | - Winnie Ky Chan
- Department of Paediatrics and Adolescent Medicine, Queen Elizabeth Hospital, Hong Kong
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Hussein NA, Ahmed KA, Osman NM, Yacoub GEE. Role of ultrasonography in screening of spinal dysraphism in infants at risk. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00722-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Spinal dysraphism (SD) encompasses congenital spinal defects that result from inappropriate fusion of the different midline osseous, mesenchymal, and neural elements. The primary tools for diagnosis of SD are both spinal ultrasonography (USG) and magnetic resonance imaging (MRI). Spinal USG is growingly being used as an initial screening modality with sensitivities and accuracies equivalent to those of MRI. Anorectal malformations (ARM) have ultimate association with many other congenital abnormalities, of which spinal dysraphism is one of the most common. The main aim of study was to assess the diagnostic accuracy of spinal USG as a screening modality in comparison with MRI in infants with closed spinal dysraphism. We also endeavored to highlight the associated spinal dysraphism radiological findings in patients with either ARM or back cutaneous stigmata.
Results
Our prospective diagnostic comparative study included 33 patients, all of whom underwent both MRI and USG. Both MRI and USG showed appreciable agreement in the assessment of spinal dysraphism. In comparison with the gold standard MRI, spinal USG revealed comparable diagnostic metrics: specificity (98.6–100%), sensitivity (66.6–91.6%), PPV (90–100%) and NPV (94.1–98.7%) in diagnosis of different types of spinal dysraphism. The main clinical presentation of nineteen patients was anorectal malformation (ARM), 11 of whom (57.9%) had evidence of associated spinal dysraphism. The most common types of ARM were cloacal malformation, recto-urethral fistula, and rectal atresia with no fistula. On the other hand, sixteen patients were mainly presented with back cutaneous stigmata, 11 of whom (68.8%) had associated spinal dysraphism. The most common presenting cutaneous stigmata were low back swelling and atypical dimples.
Conclusion
The front-line screening modality for infants with closed SD should be spinal USG, however, its main limitation is the restrained time window in the first 6 months of life. Infants with ARM should be screened for spinal anomalies, especially those with high and complex types. Infants with high-risk back cutaneous stigmata should be similarly screened, as well.
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Saekhu M, Susanto E, Handryastuti S, Ashari S, Nugroho S. Spinal dermal sinus coinciding with an infected giant epidermoid cyst in an infant presenting with constipation: a case report. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.5.2022.357-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Early diagnosis of spinal tumors is a prerequisite for achieving satisfactory neurological recovery. However, rare diseases tend to have a long diagnostic course.1 In addition, the clinical presentation of spinal tumors in most children is not apparent, moreover, spinal tumors may not show clinical symptoms if they are located in the lumbar spine and sized no more than one vertebra.2,3 Clinical presentations caused by tumors in the lumbar spine may include weakness of both limbs, impaired urination, and constipation.
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Vetrano IG, Barbotti A, Erbetta A, Mariani S, Bova SM, Colombo L, Caretti V, Marinoni F, Vestri E, Selvaggio GGO, Valentini LG. Multidisciplinary Management of Children with Occult Spinal Dysraphism: A Comprehensive Journey from Birth to Adulthood. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101546. [PMID: 36291482 PMCID: PMC9601159 DOI: 10.3390/children9101546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
Occult spinal dysraphism (OSD) comprises different forms of failure in embryogenic development that can lead to genitourinary, spinal, or lower limb alterations, thus determining progressive neurological deterioration. The correct management of children harboring OSD represents a significant issue during their life up to adulthood. However, patients often have to entertain individual consultations with each specialist. We settled on a multidisciplinary team comprising pediatric neurosurgeons, urologists, neurologists, orthopedists, and other supporting physicians. We present the results of such actions by analyzing a series of 141 children with OSD subjected to neurosurgical procedures, evaluating the impact of multidisciplinary management on outcomes. We also evaluated the specific actions according to the different ages of OSD patients from birth to adulthood to provide a schematic plan that could represent a basis for establishing and disseminating the need for a multidisciplinary approach in OSD management. The multidisciplinary team allows all consultants to see the patient together, covering specific aspects of history and examination pertinent to their management. Offering a one-stop service prevents coordination issues between the different medical teams, avoids delays or cancellations of the various appointments, optimizes cost-effectiveness, and improves efficiency and parents’ satisfaction.
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Affiliation(s)
- Ignazio G. Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milan, Italy
- Correspondence:
| | - Arianna Barbotti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Alessandra Erbetta
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Sabrina Mariani
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Stefania M. Bova
- Pediatric Neurology Unit, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Luca Colombo
- Pediatric Orthopedics and Traumatology Unit, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Valentina Caretti
- Pediatric Orthopedics and Traumatology Unit, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Federica Marinoni
- Pediatric Surgery Unit, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Elettra Vestri
- Pediatric Surgery Unit, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
| | | | - Laura G. Valentini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Sacral Spina Bifida Occulta: A Frequency Analysis of Secular Change. ANTHROPOLOGICAL REVIEW 2022. [DOI: 10.18778/1898-6773.85.2.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Substantial relaxation of natural selection beginning around 1900 changed the mutation/selection balance of modern genetic material, producing an increase in variable anatomical structures. While multiple structures have been affected, the temporal increase in variations of the sacrum, specifically, ‘Sacral Spina Bifida Occulta,’ have been reliably demonstrated on a localised scale. Calculation of largescale frequency has been hindered by the localised nature of these publications, the morphological variability of this variation, and potential pathological associations, which have produced divergent classifications, and conflicting reported rates of occurrence. A systematic review of the reported literature was conducted to provide an objective analysis of Sacral Spina Bifida Occulta frequency from 2500 BCE to the present. This review was designed to compensate for observed inconsistencies in reporting and to ascertain, for the first time, the temporal trajectory of this secular trend. A systematic review of Sacral Spina Bifida Occulta literature was conducted through the strict use of clinical meta-analysis criteria. Publications were retrieved from four databases: PubMed, Embase, the Adelaide University Library database, and Google Scholar. Data were separated into three historical groups, (1 = <1900, 2 = 1900 to 1980 and 3 = >1980), and frequency outcomes compared, to determine temporal rates of occurrence.
A total of 39/409 publications were included in the final analysis, representing data for 16,167 sacra, spanning a period of 4,500 years. Statistically significant results were obtained, with total open S1 frequency increasing from 2.34%, (79 to 1900CE), to 4.80%, (1900 to 1980CE) and to 5.43% (>1980CE). These increases were significant at p<0.0001, with Chi-squared analysis. A clear secular increase in the global frequency of Sacral Spina Bifida Occulta has been demonstrated from 1900 to the present. This research provides a novel and adaptable framework for the future assessment of variation distribution, with important implications for the fields of biological anthropology and bioarchaeology.
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Rees MA, Squires JH, Coley BD, Hoehne B, Ho ML. Ultrasound of congenital spine anomalies. Pediatr Radiol 2021; 51:2442-2457. [PMID: 34532816 DOI: 10.1007/s00247-021-05178-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/07/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Ultrasonography (US) is the first-line imaging modality for screening neonates and young infants with suspected spinal abnormalities. Whether performed for a suspicious congenital skin lesion, such as a lumbosacral tract or lipomatous mass, or abnormal neurological findings, US can help define spinal anatomy, characterize congenital spine malformations, and direct further work-up and management. The purpose of this article is to review the diagnostic imaging approach to infant spine US, including technique and indications, normal anatomy and variants with a focus on embryological origins, and classification and diagnosis of congenital spine malformations.
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Affiliation(s)
- Mitchell A Rees
- Department of Radiology, Nationwide Children's Hospital,, ED Building, 4th Floor, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Judy H Squires
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Brian D Coley
- Department of Radiology,, Cincinnati Children's Hospital Medical Cente,, Cincinnati, OH, USA.,Department of Radiology,, University of Cincinnati College of Medicine,, Cincinnati, OH, USA
| | - Brad Hoehne
- Department of Radiology, Nationwide Children's Hospital,, ED Building, 4th Floor, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital,, ED Building, 4th Floor, 700 Children's Drive, Columbus, OH, 43205, USA
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18
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Shields LB, Mutchnick IS, Daniels MW, Peppas DS, Rosenberg E. Risk of occult spinal dysraphism based on lumbosacral cutaneous manifestations. SAGE Open Med 2021; 9:20503121211037172. [PMID: 34394932 PMCID: PMC8358506 DOI: 10.1177/20503121211037172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: Occult spinal dysraphism is a congenital failure of fusion of the posterior vertebral arches with intact skin overlying the defect. Lumbosacral cutaneous manifestations are associated with a variable risk of occult spinal dysraphism. Tethered cord syndrome is a type of occult spinal dysraphism that puts abnormal traction on the spinal cord. This study analyzed neonates and infants who were referred to our pediatric urology practice and had evidence of lumbosacral cutaneous manifestation on physical examination. Methods: We reviewed the presence of lumbosacral cutaneous manifestations in neonates and infants evaluated in our pediatric urology clinic at our Institution over a 6-year period (1 March, 2015–28 February, 2021) with no prior diagnosis of lumbosacral cutaneous manifestation. All patients underwent a spinal ultrasound. Results: The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. A coccygeal pit was statistically marginally higher in abnormal versus normal spinal ultrasound (p = 0.07). Patients with only one lumbosacral cutaneous manifestation (N = 121) were significantly more likely to have a normal spinal ultrasound compared to those with two or more lumbosacral cutaneous manifestation (N = 17) (79% vs 53%, p = 0.03). Conclusion: Due to the varying risk of certain lumbosacral cutaneous manifestations with occult spinal dysraphism, all patients with a lumbosacral cutaneous manifestation should undergo spinal ultrasound. This study also highlights the importance of urodynamic studies when there are abnormal cutaneous findings. Routine physical examinations of the lumbar region for cutaneous manifestations of occult spinal dysraphism are vital to ensure prompt management of tethered cord syndrome and avoid potentially devastating consequences.
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Affiliation(s)
- Lisa Be Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY, USA
| | - Ian S Mutchnick
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY, USA
| | - Michael W Daniels
- Department of Bioinformatics & Biostatistics, University of Louisville, Louisville, KY, USA
| | - Dennis S Peppas
- Norton Children's Urology, Norton Healthcare, Louisville, KY, USA
| | - Eran Rosenberg
- Norton Children's Urology, Norton Healthcare, Louisville, KY, USA
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Behbahani M, Lam SK, Bowman R. Cutaneous Stigmata of the Spine: A Review of Indications for Imaging and Referral. Pediatr Clin North Am 2021; 68:895-913. [PMID: 34247716 DOI: 10.1016/j.pcl.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cutaneous stigmata of the midline spine are a common question in pediatrics. They are known to be related to a higher likelihood of underlying dysraphic spinal abnormalities. Clear understanding of different types of cutaneous stigmata and correlating dysraphic findings can aid in appropriate imaging workup and timely management of patient pathology. In this article, the authors review midline spinal cutaneous findings in the pediatric population with occult spinal dysraphism.
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Affiliation(s)
- Mandana Behbahani
- Division of Pediatric Neurosurgery, Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 28, Chicago, IL 60611, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 28, Chicago, IL 60611, USA
| | - Robin Bowman
- Division of Pediatric Neurosurgery, Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 28, Chicago, IL 60611, USA.
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20
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Resmi MR, Thappa DM, Chandrashekar L, Plakkal N, Ramesh A. A Hospital Based Cross Sectional Study of Midline Cutaneous Lesions in Neonates and its Association with Spinal Dysraphism Detected Using Ultrasound. Indian Dermatol Online J 2021; 12:408-411. [PMID: 34211906 PMCID: PMC8202487 DOI: 10.4103/idoj.idoj_748_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/26/2020] [Accepted: 01/25/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Spinal dysraphism occurs due to incomplete fusion of the midline mesenchymal, bony, or neural elements of the spine. The defects in the spinal cord can be associated with skin lesion since both have same embryonic origin. Aims and Objectives: This study was conducted to determine the association of midline and paramedian cutaneous lesions with spinal dysraphism by using spinal ultrasonography. Materials and Methods: Two thousand apparently healthy neonates were screened in the postnatal ward of a tertiary care center in South India. Those neonates with cutaneous lesions in the midline and paramedian region were screened for evidence of spinal dysraphism by using spinal ultrasonography. Results: Among 2000 neonates, 120 (6%) had at least one cutaneous lesion, of which 114 (5.7%) were in the midline and 6 (0.3%) were on the paramedian region of dorsal and ventral aspect of the body. Among these neonates, two cases had more than one skin lesions. The most common cutaneous lesion observed was typical dimple (82, 68%) followed by hypertrichosis (12, 10%). Ultrasonography revealed spinal anomaly in six (5%) of them. The cutaneous lesions associated with spinal dysraphism were obvious midline swelling, dermal sinus, and multiple skin lesions. Conclusion: Congenital midline and paramedian skin lesions may be the marker of spinal dysraphism. In the presence of such cutaneous lesions, only 5% of them had associated spinal anomaly in our study.
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Affiliation(s)
- M R Resmi
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Devinder Mohan Thappa
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Laxmisha Chandrashekar
- Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - A Ramesh
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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