212. Prevalence And Radiographic Analysis Of Tethered Cord In Patients With Anorectal Malformations

Authors: Luke George Foley Smith, MD; Jerome Rusin, MD; Nicholas Musgrave; Christy Monson; Asad Akhter, MD; Jillian Ploof, DO; Jeffrey Leonard, MD (Columbus, OH)


There is a paucity of data on the prevalence and radiographic associations of tethered cord (TC) in pediatric patients with anorectal malformations (ARM). We sought to characterize radiographic findings associated with ARM in order to better predict which patients may become symptomatic or require surgical release.


Radiographic and clinical data for all patient’s with the diagnosis of ARM who had a lumbosacral Magnetic Resonance Imaging (MRI) study performed at Nationwide Children’s Hospital were retrospectively reviewed and analyzed.


A total of 198 patients were reviewed, 11 of which were excluded due to limited clinical documentation. 128 (68.5%) were conservatively managed while 59 (31.55%) had a surgical intervention. Clinically, those who underwent surgery were more likely to have presented with lower extremity weakness (p=0.07) and urinary incontinence (p=<0.001). Analysis of MRIs in the surgical versus non-surgical group revealed a smaller spinal cord diameter in both the anteroposterior (AP) (p=0.001) and transverse directions and (p=<0.001), and also smaller sacral ratios in both the AP (p=<0.001) and lateral (p=<0.001) measurements. Children who underwent surgical detethering were more likely to have an abnormal conus morphology (p=0.001), with a pencil point conus shape much more common in the surgery group (p=<0.001). Additionally, conus terminating below L2 (p=<0.001), filum diameter over 1.5 mm (p=<0.001), and abnormal vertebral body alignment (p=.014) were more common in the surgical group.


Here we present clinical and radiographic factors associated with patients who went on to surgical detethering in patients with ARM. These factors can be evaluated for in the presurgical setting and used in the decision making if detethering is indicated in this patient population.