title: The horizontal sacrum as an indicator of the tethered spinal cord in spina bifida aperta and occulta.
abstract: OBJECTIVE
  The authors report on symptomatic patients with myelomeningocele (MMC) and lipomyelomeningocele (LMMC) who were found to have changes in their lumbosacral angle (LSA) corresponding to the onset of symptoms indicative of a tethered spinal cord.
  
  
  METHODS
  The authors review data obtained in these two cohorts of patients and compare the LSAs measured in the perinatal period with those seen when the patients presented with symptoms of a tethered spinal cord.
  
  
  RESULTS
  Children with LMMC, roughly one third of studied cases, were symptomatic due to a tethered spinal cord at their most recent follow-up. In children in whom the MMC was the closed form at birth, 20 of 30 had symptoms that could be indicative of a tethered spinal cord at their most recent follow-up. The LSA was altered in both groups with symptoms.
  
  
  CONCLUSIONS
  Signs and symptoms indicative of a tethered spinal cord appear to correspond to increases in the LSA.
authors.affiliation: Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, AL 35233, USA. rstubbs@uab.edu
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Cuong J
authors.initials: CJ
authors.lastname: Bui
authors.forename: Marios
authors.initials: M
authors.lastname: Loukas
authors.forename: Mohammadali M
authors.initials: MM
authors.lastname: Shoja
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
mesh_terms: D006801:Humans; D011183:Postoperative Complications; D012447:Sacrum / Q000473:pathology / Q000601:surgery; D016137:Spina Bifida Cystica / Q000601:surgery*; D016136:Spina Bifida Occulta / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology