title: Anorectal malformations associated spinal cord anomalies.
abstract: OBJECTIVE
  The present study aims to identify clinical and pathological factors that can predict the risk of spinal cord anomalies (SCA) in patients with anorectal malformations (ARM), the need for neurosurgery, and to define the impact of SCA on the outcome of patients with ARM.
  
  
  METHODS
  A 16-year retrospective analysis of all patients treated at a single tertiary children's Hospital with diagnosis of ARM. Data were collected to assess the impact of defined clinical characteristics on prevalence of SCA (detected at MRI). Children surgically treated or not for SCA were compared for age, clinical symptoms and type of anomalies at surgery or at last follow-up, respectively. Moreover, patients with intermediate/high ARMs, with or without SCA were compared for neurogenic bladder (NB), constipation, soiling and need for bowel management (BM).
  
  
  RESULTS
  Two hundred and seventy-five children were treated for ARM in the study period, 142 had spinal MRI that showed SCA in 85. Patients with SCA had significantly higher prevalence of preterm birth (p < 0.05), cardiac anomalies (p = 0.02), vertebral anomalies (p = 0.0075), abnormal sacrum (p < 0.0001), and VACTERL association (p = 0.0233). Ten patients were surgically treated for SCA. The prevalence of neurological bladder and neuro-motor deficits, of vertebral and genital anomalies, particularly cryptorchidism, was significantly higher in the operated group (p < 0.01, for each analysis). In patients with intermediate/high ARMs, no significant difference was observed between those with or without SCA, in terms of prevalence of NB, intestinal function and need for BM.
  
  
  CONCLUSIONS
  In patients with ARM, factors that can predict a higher prevalence of SCA and also determine an increased indication to neurosurgery may be identified. SCA by itself does not seem to affect the functional prognosis of children with intermediate/high ARM. These data may help physicians in stratifying the clinical and diagnostic pathway of patients with ARM.
authors.affiliation: Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy. gtotonelli@gmail.com.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Totonelli
authors.affiliation: Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Morini
authors.affiliation: Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy.
authors.forename: Vincenzo Davide
authors.initials: VD
authors.lastname: Catania
authors.affiliation: Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Paolo Maria
authors.initials: PM
authors.lastname: Schingo
authors.affiliation: Neuro-Urology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mosiello
authors.affiliation: Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Palma
authors.affiliation: Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy.
authors.forename: Barbara Daniela
authors.initials: BD
authors.lastname: Iacobelli
authors.affiliation: Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bagolan
mesh_terms: D000015:Abnormalities, Multiple / Q000453:epidemiology; D000071056:Anorectal Malformations / Q000453:epidemiology*; D003456:Cryptorchidism / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D013116:Spinal Cord / Q000002:abnormalities*; D001750:Urinary Bladder, Neurogenic / Q000453:epidemiology / Q000209:etiology
keywords: Anorectal malformations; Bowel function; Cryptorchidism; Neurogenic bladder; Spinal cord anomalies; Spinal dysraphism; Tethered cord