Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Konkret geht es um den Diabetes-Patienten mit kardiovaskulären Erkrankungen oder Risiken, die Herzinsuffizienz sowie die kardiovaskuläre Primär- und Sekundärprävention. Sind Sie hier schon auf dem neuesten Stand? Unsere Experten beleuchten, wo und warum das bisherige Procedere geändert werden soll und was in der Praxis sinnvoll ist. Holen Sie sich Ihr Update und 2 CME-Punkte beim MMW-Webinar am 24. April von 17.30 bis 19 Uhr. 
Erweiterte Suche
Anmelden
nach oben
Current Urology Reports
Erschienen in: Current Urology Reports 11/2015

01.11.2015 | Pediatric Urology (M Castellan and R Gosalbez, Section Editors)

Systematic Review of Urologic Outcomes from Tethered Cord Release in Occult Spinal Dysraphism in Children

verfasst von: Jeffrey T. White, Derek C. Samples, Juan C. Prieto, Izabela Tarasiewicz

Erschienen in: Current Urology Reports | Ausgabe 11/2015

Einloggen, um Zugang zu erhalten

Abstract

Tethered cord syndrome describes a condition of multisystem end organ dysfunction due to fixation of the spinal cord. This systematic review focuses on the closed skin variant of this condition, occult spinal dysraphism. The embryology, pathophysiology, presentation, and classification of occult spinal dysraphism are explained to develop a simple framework for discussions regarding this often confusing condition. Following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we synthesized urologic outcome data after tethered cord release in children from 17 studies performed over the past 25 years. These results prompted several conclusions. First, the different subgroups and different nomenclature of tethered cord syndrome are often confused, making interpretation of results difficult. Second, untethering has a positive effect on urologic symptoms and urodynamics parameters. Third, timing of untethering is important: early intervention prevents significant long-term traction aiming to avoid irreversible neurologic damage. Fourth, pediatric urologists and neurosurgeons have an important role in diagnosing and treating this condition and should work closely as part of a multidisciplinary team.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Yamada S, Zinke DE, Sanders D. Pathophysiology of “tethered cord syndrome”. J Neurosurg. 1981;54(4):494–503.CrossRefPubMed
2.
Blount JP, Elton S. Spinal lipomas. Neurosurg Focus. 2001;10(1), e3.PubMed
3.
Warder DE. Tethered cord syndrome and occult spinal dysraphism. Neurosurg Focus. 2001;10(1), e1.CrossRefPubMed
4.
Pourquie O et al. Lateral and axial signals involved in avian somite patterning: a role for BMP4. Cell. 1996;84(3):461–71.CrossRefPubMed
5.
Slack JMW. Essential developmental biology. 3rd ed. Chichester: Wiley; 2015. p. xi. 479 p.
6.
Shapiro E et al. Altered smooth muscle development and innervation in the lower genitourinary and gastrointestinal tract of the male human fetus with myelomeningocele. J Urol. 1998;160(3 Pt 2):1047–53. discussion 1079.CrossRefPubMed
7.•
Shen J et al. Morphology of nervous lesion in the spinal cord and bladder of fetal rats with myelomeningocele at different gestational age. J Pediatr Surg. 2013;48(12):2446–52. Authors showed that fetal rats with myelomeningocele have altered innervation of the bladder.CrossRefPubMed
8.
Nielsen LA et al. Neural tube defects and associated anomalies in a fetal and perinatal autopsy series. APMIS. 2006;114(4):239–46.CrossRefPubMed
9.
Amari F et al. Prenatal course and outcome in 103 cases of fetal spina bifida: a single center experience. Acta Obstet Gynecol Scand. 2010;89(10):1276–83.CrossRefPubMed
10.
11.
Stetler WR, Park P, Sullivan S. Pathophysiology of adult tethered cord syndrome: review of the literature. Neurosurg Focus. 2010;29(1), E2.CrossRefPubMed
12.
Bui CJ, Tubbs RS, Oakes WJ. Tethered cord syndrome in children: a review. Neurosurg Focus. 2007;23(2), E2.PubMed
13.
Powell KR et al. A prospective search for congenital dermal abnormalities of the craniospinal axis. J Pediatr. 1975;87(5):744–50.CrossRefPubMed
14.
James CCM, Lassman LP. Spina bifida occulta: orthopaedic, radiological and neurosurgical aspects. London: Academic Press, Grune & Stratton; 1981. p. x. 230 p.
15.
Hertzler DA et al. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus. 2010;29(1), E1.CrossRefPubMed
16.
Kuo MF et al. Tethered spinal cord and VACTERL association. J Neurosurg. 2007;106(3 Suppl):201–4.PubMed
17.•
Kucera JN et al. The simple sacral dimple: diagnostic yield of ultrasound in neonates. Pediatr Radiol. 2015;45(2):211–6. Retrospective review of the utility of ultrasound for a simple sacral dimple. Ultrasound was helpful in patients less than 6 months of age. Abnormal findings were not predictive of surgery at centers with a conservative management strategy.CrossRefPubMed
18.
Wilson DA, Prince JR. John Caffey award. MR imaging determination of the location of the normal conus medullaris throughout childhood. AJR Am J Roentgenol. 1989;152(5):1029–32.CrossRefPubMed
19.
Uchino A, Mori T, Ohno M. Thickened fatty filum terminale: MR imaging. Neuroradiology. 1991;33(4):331–3.CrossRefPubMed
20.
Wolf S, Schneble F, Tröger J. The conus medullaris: time of ascendence to normal level. Pediatr Radiol. 1992;22(8):590–2.CrossRefPubMed
21.
Drake JM. Surgical management of the tethered spinal cord—walking the fine line. Neurosurg Focus. 2007;23(2), E4.CrossRefPubMed
22.
Pang D. Split cord malformation: part II: clinical syndrome. Neurosurgery. 1992;31(3):481–500.CrossRefPubMed
23.
Saifuddin A, Burnett SJ, White J. The variation of position of the conus medullaris in an adult population. A magnetic resonance imaging study. Spine. 1998;23(13):1452–6.CrossRefPubMed
24.
van Leeuwen R, Notermans NC, Vandertop WP. Surgery in adults with tethered cord syndrome: outcome study with independent clinical review. J Neurosurg. 2001;94(2 Suppl):205–9.PubMed
25.
Finn MA, Walker ML. Spinal lipomas: clinical spectrum, embryology, and treatment. Neurosurg Focus. 2007;23(2), E10.PubMed
26.
Pang D, Dias MS, Ahab-Barmada M. Split cord malformation: part I: a unified theory of embryogenesis for double spinal cord malformations. Neurosurgery. 1992;31(3):451–80.CrossRefPubMed
27.
Pang D. Ventral tethering in split cord malformation. Neurosurg Focus. 2001;10(1), e6.PubMed
28.
Proctor MR, Scott RM. Long-term outcome for patients with split cord malformation. Neurosurg Focus. 2001;10(1), e5.PubMed
29.
Proctor MR, Bauer SB, Scott RM. The effect of surgery for split spinal cord malformation on neurologic and urologic function. Pediatr Neurosurg. 2000;32(1):13–9.CrossRefPubMed
30.
Hayden JA, Cote P, Bombardier C. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006;144(6):427–37.CrossRefPubMed
31.
Abrahamsson K, Olsson I, Sillen U. Urodynamic findings in children with myelomeningocele after untethering of the spinal cord. J Urol. 2007;177(1):331–4. discussion 334.CrossRefPubMed
32.•
Broderick KM, et al. Utility of urodynamics in the management of the asymptomatic tethered cord in children. World J Urol. 2015;33(8):1139–42. The authors performed a retrospective review of tethered cord syndrome after untethering in patients with abnormal MRI findings. Though the authors believed that surgery in asymptomatic patients was not indicated, this study actually supported the natural history of the disease as discussed by Wang et al.
33.••
Kearns J et al. Urodynamic studies in spinal cord tethering. Childs Nerv Syst. 2013;29(9):1589–600. Thorough description of the urodynamic evaluation and treatment of patients with tethered cord syndrome both pre- and post-tethered cord release.CrossRefPubMed
34.
35.
Heuer GG, Adzick NS, Sutton LN. Fetal myelomeningocele closure: technical considerations. Fetal Diagn Ther. 2015;37(3):166–71.CrossRefPubMed
36.
Phuong LK, Schoeberl KA, Raffel C. Natural history of tethered cord in patients with meningomyelocele. Neurosurgery. 2002;50(5):989–93. discussion 993.PubMed
37.
Bowman RM et al. Tethered cord release: a long-term study in 114 patients. J Neurosurg Pediatr. 2009;3(3):181–7.CrossRefPubMed
38.
Brown E et al. Prevalence of incidental intraspinal lipoma of the lumbosacral spine as determined by MRI. Spine. 1994;19(7):833–6.CrossRefPubMed
39.
Nogueira M et al. Tethered cord in children: a clinical classification with urodynamic correlation. J Urol. 2004;172(4 Pt 2):1677–80. discussion 1680.CrossRefPubMed
40.
Guerra LA et al. Outcome in patients who underwent tethered cord release for occult spinal dysraphism. J Urol. 2006;176(4 Pt 2):1729–32.CrossRefPubMed
41.
Metcalfe PD et al. Treatment of the occult tethered spinal cord for neuropathic bladder: results of sectioning the filum terminale. J Urol. 2006;176(4 Pt 2):1826–9. discussion 1830.CrossRefPubMed
42.•
Frainey BT et al. Predictors of urinary continence following tethered cord release in children with occult spinal dysraphism. J Pediatr Urol. 2014;10(4):627–33. This is a retrospective review of occult spinal dysraphism patients searching for predictors of post-operative continence based on pre-surgical parameters. The conclusion that pre-operative continence (lack of pre-operative symtpoms) is predictive of post-operative continence (good urological outcomes) supports the work of Wang et al.CrossRefPubMed
43.••
Yener S et al. The effect of untethering on urologic symptoms and urodynamic parameters in children with primary tethered cord syndrome. Urology. 2015;85(1):221–6. Authors performed a prospective review comparing pre- and post-operative urinary symptoms and urodynamic parameters. Untethering improved both symptoms and urodynamics; no coordination was seen between these parameters. Furthermore they demonstrated that the most significant improvements were seen in patients without pre-operative symptoms.CrossRefPubMed
44.
Khoury AE et al. Occult spinal dysraphism: clinical and urodynamic outcome after division of the filum terminale. J Urol. 1990;144(2 Pt 2):426–8. discussion 428–9, 443–4.PubMed
45.
Atala A et al. Bladder functional changes resulting from lipomyelomeningocele repair. J Urol. 1992;148(2 Pt 2):592–4.PubMed
46.
Wu HY et al. Long-term benefits of early neurosurgery for lipomyelomeningocele. J Urol. 1998;160(2):511–4.CrossRefPubMed
47.
Macejko AM et al. Clinical urological outcomes following primary tethered cord release in children younger than 3 years. J Urol. 2007;178(4 Pt 2):1738–42. discussion 1742–3.CrossRefPubMed
48.
Kumar R et al. Evaluation of clinico-urodynamic outcome of bladder dysfunction after surgery in children with spinal dysraphism—a prospective study. Acta Neurochir (Wien). 2008;150(2):129–37.CrossRef
49.•
Kim SW et al. Six-month postoperative urodynamic score: a potential predictor of long-term bladder function after detethering surgery in patients with tethered cord syndrome. J Urol. 2014;192(1):221–7. Retrospective review of urodynamic data in occult spinal dysraphism patients both pre- and post-tethered cord release as reflected in a urodynamic score. They proposed that the urodynamic score at six months post-untethering can predict long-term urologic outcomes.CrossRefPubMed
50.
Hoffman HJ et al. Management of lipomyelomeningoceles. Experience at the Hospital for Sick Children, Toronto. J Neurosurg. 1985;62(1):1–8.CrossRefPubMed
51.
Kanev PM et al. Management and long-term follow-up review of children with lipomyelomeningocele, 1952–1987. J Neurosurg. 1990;73(1):48–52.CrossRefPubMed
52.
Pierre-Kahn A et al. Intraspinal lipomas with spina bifida. Prognosis and treatment in 73 cases. J Neurosurg. 1986;65(6):756–61.CrossRefPubMed
53.
Arikan N et al. Role of magnetic resonance imaging in children with voiding dysfunction: retrospective analysis of 81 patients. Urology. 1999;54(1):157–60. discussion 160–1.CrossRefPubMed
54.
Lavallee LT et al. Urodynamic testing—is it a useful tool in the management of children with cutaneous stigmata of occult spinal dysraphism? J Urol. 2013;189(2):678–83.CrossRefPubMed
Metadaten
Titel
Systematic Review of Urologic Outcomes from Tethered Cord Release in Occult Spinal Dysraphism in Children
verfasst von
Jeffrey T. White
Derek C. Samples
Juan C. Prieto
Izabela Tarasiewicz
Publikationsdatum
01.11.2015
Verlag
Springer US
Erschienen in
Current Urology Reports / Ausgabe 11/2015
Print ISSN: 1527-2737
Elektronische ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-015-0550-6

Weitere Artikel der Ausgabe 11/2015

Current Urology Reports 11/2015 Zur Ausgabe

Urothelial Cancer (A Sagalowsky, Section Editor)

Quality of Life Outcomes for Bladder Cancer Patients Undergoing Bladder Preservation with Radiotherapy

Men’s Health (R Carrion and C Yang, Section Editors)

The Impact of Medical and Surgical Treatment for Benign Prostatic Hypertrophy on Erectile Function

Kidney Diseases (G Ciancio, Section Editor)

Robot-assisted Partial Nephrectomy for Endophytic Tumors

Urothelial Cancer (A Sagalowsky, Section Editor)

Patient Psoas Muscle Mass as a Predictor of Complications and Survival After Radical Cystectomy

Pediatric Urology (M Castellan and R Gosalbez, Section Editors)

Stem Cell Therapy: Current Applications and Potential for Urology

Neu im Fachgebiet Urologie

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Varikozelen bei Jugendlichen: Das Für und Wider der Operation

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Prostatakarzinom: EU initiiert neues Screeningkonzept

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Blasenkarzinom – Biomarker statt Zytologie?
weitere anzeigen

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen