title: Tethered cord in patients with anorectal malformation: preliminary results.
abstract: BACKGROUND
  A tethered cord (TC) has been reported in as much as 50% of the patients affected by anorectal malformation (ARM). No guidelines for timing and modality of diagnosis and treatment have been established. We present the preliminary results of a multidisciplinary protocol carried out at our center.
  
  
  METHODS
  Seventy-four ARM patients underwent spinal magnetic resonance imaging (MRI). All TC patients underwent videourodynamic (UD), somatosensory-evoked potentials (SEPs), and neurological examination at baseline and, if normal, at 5 and 10 years of age. Conversely, when UD or SEP abnormalities were detected the follow-up was individually tailored at shorter time.
  
  
  RESULTS
  25/74 patients had a neuroradiological TC (33.7%). Based on the results of UD, SEP, and neurological status, four patients were untethered, eight are possible candidates, nine are stable, and four were excluded because of incomplete data.
  
  
  CONCLUSIONS
  Tethered cord is frequent in ARM patients. Because neurological deficits secondary to TC can contribute to neurological disability, we recommend routine MRI examination and a multidisciplinary program of follow-up in cases of TC. Preliminary results suggest the combined use of SEPs and UD could represent a useful adjunct to clinical examination in patients in whom a "wait and see" approach is preferred to the prophylactic surgery.
authors.affiliation: Child Neurology and Clinical Neurophysiology Unit, University of Padua, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Suppiej
authors.forename: L
authors.initials: L
authors.lastname: Dal Zotto
authors.forename: A
authors.initials: A
authors.lastname: Cappellari
authors.forename: A
authors.initials: A
authors.lastname: Traverso
authors.forename: M
authors.initials: M
authors.lastname: Castagnetti
authors.forename: P
authors.initials: P
authors.lastname: Drigo
authors.forename: P
authors.initials: P
authors.lastname: Midrio
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D003950:Diagnostic Techniques, Urological; D004065:Digestive System Abnormalities / Q000150:complications / Q000175:diagnosis*; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009436:Neural Tube Defects / Q000150:complications / Q000175:diagnosis*; D009460:Neurologic Examination; D012007:Rectum / Q000002:abnormalities*; D013979:Tibial Nerve; D014563:Urodynamics
references.citation: Eur J Pediatr Surg. 2007 Dec;17(6):408-11
references.pmid: 18072026
references.citation: Childs Nerv Syst. 1993 Sep;9(6):328-30
references.pmid: 8269414
references.citation: J Neurosurg. 2006 May;104(5 Suppl):305-8
references.pmid: 16848086
references.citation: J Neurosurg. 2006 May;104(5 Suppl):302-4
references.pmid: 16848085
references.citation: J Pediatr Surg. 1995 Mar;30(3):488-90
references.pmid: 7760249
references.citation: Can J Neurol Sci. 1994 Nov;21(4):325-30
references.pmid: 7874616
references.citation: Eur J Pediatr Surg. 1996 Jun;6(3):159-62
references.pmid: 8817209
references.citation: Pediatr Neurosurg. 1990-1991;16(1):3-7; discussion 7
references.pmid: 2133407
references.citation: J Urol. 2006 Jul;176(1):314-24
references.pmid: 16753432
references.citation: Semin Pediatr Neurol. 1997 Sep;4(3):192-208
references.pmid: 9323789
references.citation: Pediatr Neurosurg. 1993;19(1):25-30
references.pmid: 8422325
references.citation: Semin Pediatr Surg. 1995 Feb;4(1):35-47
references.pmid: 7728507
references.citation: J Pediatr Surg. 1984 Dec;19(6):838-42
references.pmid: 6520683
references.citation: J Pediatr Surg. 2004 May;39(5):773-7
references.pmid: 15137017
references.citation: Neurosurgery. 1993 Jun;32(6):1025-7; discussion 1027-8
references.pmid: 8327077
references.citation: Neuroradiology. 2000 Jul;42(7):471-91
references.pmid: 10952179
references.citation: Eur J Pediatr Surg. 1993 Oct;3(5):309-12
references.pmid: 8292587
references.citation: Neurourol Urodyn. 2002;21(3):261-74
references.pmid: 11948720
references.citation: J Pediatr Surg. 2008 Oct;43(10):1935-8
references.pmid: 18926237
references.citation: J Pediatr Surg. 1997 Mar;32(3):462-8
references.pmid: 9094019
references.citation: J Urol. 2002 Sep;168(3):1147-9
references.pmid: 12187257
references.citation: Orphanet J Rare Dis. 2007 Jul 26;2:33
references.pmid: 17651510
references.citation: J Pediatr Surg. 2002 Jul;37(7):966-9; discussion 966-9
references.pmid: 12077750
references.citation: J Neurosurg. 2000 Apr;92(4):626-30
references.pmid: 10761651
references.citation: Neurosurg Focus. 2004 Feb 15;16(2):E6
references.pmid: 15209489