Introduction of a urodynamic score to detect pre- and postoperative neurological deficits in children with a primary tethered cord.
OBJECTIVE
An increasing number of asymptomatic children are diagnosed with occult spinal dysraphism, raising the question of their optimal management. Urodynamic study (UDS) is the most reliable method of detecting neuro-urological abnormalities in these children. The rate of postoperative retethering ranges from 10 to 20% and is not always immediately clinically significant. The aim of this prospective study was to develop a reliable method that could be used in the preoperative assessment and postoperative follow-up of children with a tethered cord syndrome (TCS).


METHODS
From 1989 to 1997, 15 children underwent spinal cord untethering for TCS. Preoperatively, patients were assessed with MRI and UDS. Postoperative UDS were repeated at 6- to 12-month intervals. Four UDS parameters were identified, graded, and added to obtain a UDS score. A group of 38 children without dysraphic condition was used as control and allowed the calculation of a normal score.


CONCLUSIONS
There was a statistically significant difference in the preoperative UDS scores between the control group and the study group ( p<0.001). Postoperatively, there was a statistically significant improvement ( p<0.001) in UDS scores. UDS score is a reliable tool for identifying and quantifying neuro-urological disorders in patients with TCS. Postoperatively, this score was useful in the early diagnosis of spinal cord retethering.
Meyrat
Blaise Julien
BJ
Department of Pediatric Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. blaise-julien.meyrat@chuv.hospvd.ch
Tercier
Stéphan
S
Lutz
Nicolas
N
Rilliet
Bénédict
B
Forcada-Guex
Margarita
M
Vernet
Olivier
O
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009436:Neural Tube Defects / Q000175:diagnosis / Q000601:surgery* / Q000652:urine; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000503:physiopathology*; D011184:Postoperative Period; D015203:Reproducibility of Results; D013116:Spinal Cord / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology; D014549:Urinary Incontinence / Q000503:physiopathology*; D014563:Urodynamics; D014894:Weights and Measures