title: Spinal cord transection before scoliosis correction in myelomeningocele may improve bladder function.
abstract: OBJECTIVE
  In patients with myelomeningocele (MMC) and coexistent scoliosis, a spinal cord transection (SC-transection) is sometimes performed before scoliosis correction to prevent traction on the myelum after stretching the spinal column. Performing a SC-transection may have positive effects on bladder function, especially in case of refractory detrusor-sphincter dyssynergia. This study investigates the effects of SC-transection on lower and upper urinary tract outcomes.
  
  
  METHODS
  All children with MMC who underwent scoliosis correction (1989-2009) were retrospectively reviewed. Cases were defined as those who underwent a SC-transection before scoliosis correction, whereas the control group comprised children who had a scoliosis correction alone. Urodynamic and clinical outcomes were examined.
  
  
  RESULTS
  A total of 7 cases and 13 controls were identified. Postoperatively, compared to the control group, cases had relatively more often improvement of compliance (improvement in 6/7 vs. 9/13) and bladder capacity (improvement in 6/7 vs. 8/13). No effect of SC-transection was found on incontinence severity, clean intermittent catheterization frequency, use of antimuscarinic drugs, or signs of renal damage on ultrasound.
  
  
  CONCLUSIONS
  SC-transection before scoliosis correction in children with MMC without lower extremity function, may improve bladder function with respect to bladder compliance and bladder capacity. Changes in symptoms or renal ultrasound were not found. No harmful effects of SC-transection were found, indicating that this procedure can be performed safely with respect to bladder function in these patients. Whether or not SC-transection should be recommended during scoliosis correction in patients with MMC to improve bladder function requires further study.
authors: Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Josephine I
authors: JI
authors: Linthorst
authors: Paul W
authors: PW
authors: Veenboer
authors: Pieter
authors: P
authors: Dik
authors: Hans E H
authors: HE
authors: Pruijs
authors: Sen K S
authors: SK
authors: Han
authors: Laetitia M O
authors: LM
authors: de Kort
authors: Tom P V M
authors: TP
authors: de Jong
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013116:Spinal Cord / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics
keywords: bladder; cordotomy; myelomeningocele; spina bifida; spinal cord transection