Impact of urodynamic studies on the surgical management of spinal cord tethering

Details

Serval ID
serval:BIB_DF2D9DC45408
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of urodynamic studies on the surgical management of spinal cord tethering
Journal
Journal of Neurosurgery
Author(s)
Vernet  O., Farmer  J. P., Houle  A. M., Montes  J. L.
ISSN
0022-3085 (Print)
Publication state
Published
Issued date
10/1996
Volume
85
Number
4
Pages
555-9
Notes
Journal Article --- Old month value: Oct
Abstract
To determine the usefulness of urodynamic studies in the management of children with a suspected tethered spinal cord, the authors retrospectively reviewed case records of 25 patients evaluated both pre- and postoperatively using this diagnostic adjunct. All patients were also evaluated with magnetic resonance imaging or computerized tomography myelography. Seven patients who presented initially with orthopedic deformity, skin stigmata, and neurological problems underwent primary cord untethering (Group 1). All seven patients were urologically asymptomatic; all but one had normal findings on urodynamic study. Eighteen patients with prior myelomeningocele closure underwent secondary untethering (Group 2). They presented with urological (11 cases), neurological (three cases), or both urological and neurological (four cases) deterioration. All patients underwent surgery via a microsurgical technique. At a mean follow-up time of 2 years, the only Group 1 patient with preoperative abnormal urodynamic findings normalized following untethering, whereas another asymptomatic patient showed worsened results on his postoperative study. In Group 2, all seven patients with preoperative neurological deterioration improved. Ten of the 15 patients who had isolated or associated preoperative clinical urological deterioration improved or stabilized, whereas five displayed continued deterioration in their bladder function. With respect to urodynamic studies, there was a significant increase in total and pressure-specific bladder capacities following untethering. We conclude that urodynamic studies are useful both diagnostically and in follow-up examinations of patients with tethered cord, that disturbances identified by these studies often precede clinical manifestations of deterioration, and that spinal cord untethering favorably influences the urological status in most patients.
Keywords
Adolescent Child Child, Preschool Female Humans Infant Male Prognosis Spinal Cord Diseases/*surgery/urine Spinal Dysraphism/*surgery Urodynamics
Pubmed
Web of science
Create date
25/01/2008 13:13
Last modification date
20/08/2019 16:03
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