Evaluation and treatment for spinal cord tethering in patients with anorectal malformations.
BACKGROUND
It has recently been recognized that there is a close relationship between spinal cord tethering (SCT) and congenital anorectal malformation (ARM).


METHODS
We evaluated spinal MRI examinations of 28 patients with ARM (14 boys and 14 girls) aged 5 months to 9 years. All patients diagnosed with SCT subsequently underwent operation. Patients were divided into high and low type ARM groups. We reviewed the relationship between SCT and ARM, and evaluated the untethering surgery.


RESULTS
We evaluated 14 boys (high, 9; low, 5) and 14 girls (high, 4; low, 10). Of these 28 patients, 13 had SCT on MRI. Five out of 13 patients with high type ARM and 8 out of 15 patients with low type ARM had SCT. Seven out of 10 girls with low type ARM had SCT. Ten of these 13 patients with SCT experienced bowel/urological/orthopedic symptoms. SCT symptoms progressed prior to operation in the 2 patients who underwent untethering surgery a few years after their initial MRI examination. Postoperatively, orthopedic symptoms disappeared completely in all patients, but other symptoms did not.


CONCLUSIONS
Based on the results of this study, we recommend routine MRI examination of patients with ARM and early untethering surgery in cases with SCT.
Uchida
K
K
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, Japan. keiichiuchida0815@yahoo.co.jp
Inoue
M
M
Matsubara
T
T
Otake
K
K
Koike
Y
Y
Okugawa
Y
Y
Kawamoto
A
A
Miki
C
C
Kusunoki
M
M
D000015:Abnormalities, Multiple; D001003:Anal Canal / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004065:Digestive System Abnormalities / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009436:Neural Tube Defects / Q000175:diagnosis / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D012007:Rectum / Q000002:abnormalities*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome