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Spinal dysraphism with anorectal malformation: lumbosacral magnetic resonance imaging evaluation of 120 patients

 Seong Min Kim  ;  Hye Kyung Chang  ;  Mi Jung Lee  ;  Kyu Won Shim  ;  Jung Tak Oh  ;  Dong Seok Kim  ;  Myung Joon Kim  ;  Seok Joo Han 
 JOURNAL OF PEDIATRIC SURGERY, Vol.45(4) : 769-776, 2010 
Journal Title
Issue Date
Anal Canal/abnormalities* ; Child, Preschool ; Digestive System Abnormalities/epidemiology ; Female ; Humans ; Infant ; Infant, Newborn ; Intestinal Fistula/epidemiology ; Lumbosacral Region ; Magnetic Resonance Imaging* ; Male ; Neural Tube Defects/diagnosis ; Neural Tube Defects/epidemiology ; Neural Tube Defects/surgery ; Prevalence ; ROC Curve ; Rectum/abnormalities* ; Republic of Korea/epidemiology ; Spinal Dysraphism/diagnosis* ; Spinal Dysraphism/epidemiology* ; Spinal Dysraphism/surgery
Spinal dysraphism ; Tethered spinal cord ; Anorectal malformation ; Sacral ratio ; Magnetic resonance imaging
PURPOSE: We evaluated the prevalence of spinal dysraphism (SD) in patients with anorectal malformation (ARM) by magnetic resonance imaging (MRI). METHODS: From January 2002 to March 2009, 120 patients with ARM who underwent anorectal reconstruction were evaluated for SD with sacral plain film, spinal ultrasonography (US), and lumbosacral MRI. We adopted Krickenbeck international classification of ARM. RESULTS: Spinal dysraphism was present in 41 (34.2%) of 120 patients with ARM, 3 (13.0%) of 23 patients with perineal fistula, 7 (29.2%) of 24 patients with vestibular fistula, 4 (36.4%) of 11 patients with rectovesical fistula, 18 (40.9%) of 44 patients with rectourethral fistula, and 9 (60.0%) of 15 patients with cloacal anomaly (P = .04). Among 41 patients having SD detected by MR, 26 patients (26/41; 63.4%) underwent detethering surgery for tethered spinal cord. The mean sacral ratio (SR) in patients who underwent detethering surgery (0.54 +/- 0.19) was significantly lower than in patients who did not undergo detethering surgery (0.69 +/- 0.13; P < .001). The optimal cutoff for the SR value predicting SD requiring detethering surgery was 0.605, with sensitivity of 65.4% and specificity of 77.7%. CONCLUSIONS: Spinal dysraphism is common in patients with ARM, and its prevalence is higher in patients with complex ARM. Spinal anomalies can occur even with benign types of ARM and, therefore, that all patients should be screened. Magnetic resonance imaging is useful in detecting occult SD that may be missed by conventional radiologic evaluation, physical examination, and spinal US. We further recommend a lumbosacral MRI examination in those whose SR is lower than 0.6
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Seok(김동석)
Kim, Myung Joon(김명준) ORCID logo https://orcid.org/0000-0002-4608-0275
Kim, Seong Min(김성민)
Shim, Kyu Won(심규원) ORCID logo https://orcid.org/0000-0002-9441-7354
Oh, Jung Tak(오정탁)
Lee, Mi-Jung(이미정) ORCID logo https://orcid.org/0000-0003-3244-9171
Chang, Hye Kyung(장혜경)
Han, Seok Joo(한석주) ORCID logo https://orcid.org/0000-0001-5224-1437
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