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Table of Contents
Vol. 42, No. 1, 2006
Issue release date: December 2005
Pediatr Neurosurg 2006;42:4–13
(DOI:10.1159/000089503)

Prevalence of Primary Tethered Cord Syndrome Associated with Occult Spinal Dysraphism in Primary School Children in Turkey

Bademci G. · Saygun M. · Batay F. · Cakmak A. · Basar H. · Anbarci H. · Unal B.
Departments of aNeurosurgery, bPublic Health, cUrology and dRadiology, Faculty of Medicine, University of Kirikkale, Kirikkale, and eDivision of Neurosurgery, Bayindir Hospital Neurological Sciences Center, Ankara, Turkey

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Abstract

The prevalence and associated factors of primary tethered cord syndrome (PTCS) in primary school children were investigated. A cross-sectional study was performed in four demographically different primary schools in Turkey. Demographic, familial and physical data were collected from 5,499 children based on enuresis as a predominant symptom and dermatologic and orthopedic signs as clues of occult spinal dysraphism. Statistical analysis and input of the data were carried out with the SPSS package program 10.00, and logistic regression analysis was used to identify discriminating factors between enuretic children with or without neurologic signs. Of 5,499 analyzed children, 422 (7.7%) had enuresis nocturna, and 19.9% of 422 children had also daytime incontinence. Sixteen of these 422 enuretic children (3.8%) had several dermatologic signs. Five of them had spina bifida on plain radiographies, and 4 of them had cord tethering on lumbar MRI. Fifteen of 422 enuretic children (3.7%) had gait disturbances and orthopedic anomalies without cutaneous manifestations. Six of 15 children had spina bifida on plain graphies and 2 of them had tethered cord syndrome on MRI. The general prevalence of PTCS was found to be 0.1% of 5,499 analyzed children and 1.4% of enuretic children. A good outcome after untethering was found in 83.0% in this series. Practitioners should be aware of these clues of occult spinal dysraphism and resort to further radiologic and neurosurgical assessment. Early surgical intervention may halt the progression of the neurologic deficits and stabilize or reverse symptoms.



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References

  1. Proctor MR, Bauer SB, Scott RM: The effect of surgery for split spinal cord malformation on neurologic and urologic function. Pediatr Neurosurg 2000;32:13–19.
  2. Yamada S, Zinke DE, Sanders D: Pathophysiology of tethered cord syndrome. J Neurosurg 1981;54:494–503.
  3. Moore KL: The nervous system; in Persaud TVN (ed): The Developing Human: Clinically Oriented Embryology, ed 6. Philadelphia, Saunders Co, 1998, pp 452–465.
  4. Nogueira M, Greenfield P, Wan J, Santana A, Li V: Tethered cord in children: A clinical classification with urodynamic correlation. J Urol 2004;172:1677–1680.
  5. Raicevic M, Abramovic D, Mihajlovic M, Petronic I, Vidosavljevic M: Occult spinal dysraphia (abstract). Srp Arh Celok Lek 2004;132(suppl 1):111–114.

    External Resources

  6. Epelman M, Makhoul IR, Golsher D, Sujov P: Radiological case of the month: occult spinal dysraphism (tethered cord, diastematomyelia, and spinal lipoma). Arch Pediatr Adolesc Med 2002;156:407–408.
  7. Mclone DB, Naidich TP: The tethered spinal cord; in McLaurin RL, Venes JL, Schut L, Epstein F (eds): Pediatric Neurosurgery. Philadelphia, Saunders Co, 1989.
  8. Sherburn EW, Park TS: Occult spinal dysraphism. Contemp Neurosurg 1997;19:1–9.
  9. World Health Organization. The ICD-19. Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research. Geneva, WHO, 1993.
  10. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. DSM-IV, ed 4. Washington, American Psychiatry Press, 1995.
  11. Raghavan N, Barkovich AJ, Edwards M, Norman D: MR Imaging in the tethered spinal cord syndrome. AJR 1989;152:843–852.
  12. Selcuki M, Vatansever S, Inan S, Erdemli E, Bagdatoglu C, Polat A: Is a filum terminale with a normal appearance really normal? Childs Nerv Syst 2003;19:3–10.
  13. Moufarrij NA, Palmer JM, Hahn JF, Weinstein MA: Correlation between magnetic resonance imaging and surgical findings in the tethered spinal cord. Neurosurgery 1989;25:341–346.
  14. Yamada S, Won DJ, Siddiqi J, Yamada SM: Tethered cord syndrome: overview of diagnosis and treatment. Neurol Res 2004;26:719–721.
  15. Mapstone TB: Management of tethered spinal cord. Neurosurg Q 1994;4:82–91.

    External Resources

  16. Satar N, Bauer SB, Shefner J, Kelly MD, Darbey MM: The effects of delayed diagnosis and treatment in patients with an occult spinal dysraphism. J Urol 1995;154:754–758.
  17. Wehby MC, O’Hollaren PS, Abtin K, Hume JL, Richards BJ: Occult tight filum terminale syndrome: results of surgical untethering. Pediatr Neurosurg 2004;40:51–57.
  18. Warf BC, Scott RM, Barnes PD, Hendren WH: Tethered spinal cord in patients with anorectal and urogenital malformations. Pediatr Neurosurg 1993;19:25–30.
  19. Humpreys RP: Clinical evaluation of cutaneous lesions of the back: spinal signatures that do not go away. Clin Neurosurg 1996;43:175–187.

    External Resources

  20. Guggisberg D, Hadj-Rabia S, Viney C, Bodemer C, Brunelle F, Zerah M, Pierre-Kahn A, de Prost Y, Hamel D: Skin markers of occult spinal dysraphism in children: a review of 54 cases. Arch Dermatol 2004;140:1109–1115.
  21. Drolet BA, Boudreau C: When good is not good enough: the predictive value of cutaneous lesions of the lumbosacral region for occult spinal dysraphism. Arch Dermatol 2004;140:1153–1155.
  22. Birol A, Bademci G: Faun tail: diagnosis of occult spinal dysraphism with a rare cutaneous marker. J Dermatol 2004;31:251–252.
  23. Piatt JH: Skin hemangiomas and occult spinal dysraphism. J Neurosurg Spine 2004;100:81–82.
  24. Ward PJ, Clarke NM, Fairhurst JJ: The role of magnetic resonance imaging in the investigation of spinal dysraphism in the child with lower limb abnormality. J Pediatr Orthop B 1998;7:141–143.
  25. Michelson DJ, Ashwal S: Tethered cord syndrome in childhood: diagnostic features and relationship to congenital anomalies. Neurol Res 2004;26:745–753.
  26. Pacheco JE, Ballesteros MC, Jayakar P, Morrison G, Ragheb J, Medina LS: Occult spinal dysraphism: evidence-based diagnosis and treatment. Neuroimag Clin North Am 2003;13:327–334.
  27. Medina LS, Crone K, Kuntz KM: Newborns with suspected occult spinal dysraphism: a cost effectiveness analysis of diagnostic strategies. Pediatrics 2001;108:E101.

    External Resources

  28. CDC: Spina bifida incidence at birth – United States. MMWR Morb Mortal Wkly Rep 1992;41:497–500.
  29. Medina LS, Orfali M, Zurakowski D, Poussaint TY, DiCanzio J, Barnes PD: Occult lumbosacral dysraphism in children and young adults: diagnostic performance of fast screening and conventional MR imaging. Radiology 1999;221:767–771.
  30. Brophy JD, Sutton LN, Zimmerman RA, Bury E, Schut L: Magnetic resonance imaging of lipomyelomeningocele and tethered cord. Neurosurgery 1989;25:336–340.
  31. Jacome PE, Ballesteros MC, Jayakar P, Morrison G, Ragheb J, Medina LS: Occult spinal dysraphism: evidence-based diagnosis and treatment. Neuroimag Clin North Am 2003;13:327–334.
  32. Tripathi RP, Sharma A, Jena A, Gulati P, Jain RK: Magnetic resonance imaging in occult spinal dysraphism. Australas Radiol 1992;36:8–14.
  33. Robinson AJ, Russell S, Rimmer S: The value of ultrasonic examination of the lumbar spine in infants with specific reference to cutaneous markers of occult spinal dysraphism. Clin Radiol 2005;60:72–77.
  34. Henriques JG, Pianetti FG, Costa PR, Henriques KS, Perpetuo FO: Screening of occult spinal dysraphism by ultrasonography. Arq Neuropsiquiatr 2004;62:701–706.


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