Can we predict spinal bone anomalies in patients with anorectal malformations (ARM)? | 20 years | Single institution retrospective study on patients w/ ARM per the Wingspread classification | 348 PATIENTS with ARM were treated | 55% male | Mean gestational age - 39 weeks | 26% born before 37th week of gestation | 20% had VACTERL association | 8% had genetic syndromes | Imaging Results | 70% spine MRI performed. -SCA in 60%- | 64% spinal US performed. -Was normal in 84%- | 49% with normal US had SCA on MRI. | SCA were found in | 70% with vertebral anomalies | 76% with sacral anomalies | 11,5% of patients with SCA required neurosurgical intervention. | Conclusion: Despite relation between sacral/vertebral anomalies and SCA in patients with ARMs, spinal cord MRI should be performed to assess for SCA. | https://pubmed.ncbi.nlm.nih.gov/34167803/ | Source: Bambino Gesù Children's Hospital, IRCCS, Rome, Italy & University of Rome 'Tor Vergata' | @StayCurrentMD | @EmTombash @emencisco @RodGerardo
Predictive value of spinal bone anomalies for spinal cord abnormalities in patients with anorectal malformations
Infographic · Nov 2021 · 1 min read
In brief
In brief
Large retrospective study of 348 ARM patients found 42% had spinal cord anomalies on MRI, with strong correlation to sacral/vertebral bone defects. However, SCA occurred even without visible bone anomalies, leading authors to recommend routine spinal MRI for all ARM patients regardless of radiographic findings.
- 70-76% of ARM patients with vertebral or sacral anomalies have spinal cord abnormalities on MRI, but absence of bone anomalies doesn't exclude SCA
- Spinal dysraphism (most common SCA) was found in 94 patients, with 96% showing fatty filum terminale
- Higher-level anorectal malformations correlate significantly with increased prevalence of both sacral/vertebral and spinal cord anomalies
- MRI screening recommended for ALL ARM patients regardless of visible spinal bone anomalies, as most SCA patients are initially asymptomatic
- Only 11.5% of SCA patients showed neurological symptoms requiring neurosurgical intervention, emphasizing need for proactive surveillance
Written by the GCMD Library team from the infographic.
A teal and yellow infographic divided into sections with icons including a calendar, patient demographics illustrations, an ultrasound probe, and a spine illustration. The layout flows from study design at top, through patient characteristics and imaging results in the middle, to conclusions at bottom. Key statistics are displayed in large yellow and white text against teal backgrounds.
Aim: To evaluate the correlation between sacral/vertebral anomalies and spinal cord anomalies (SCA) on MRI, in patients with anorectal malformation (ARM). Methods: Patients with ARM consecutively treated between January 1999 and August 2019 were included. Radiological imaging of sacrum and spine were retrospectively analyzed and correlated to the presence of SCA at MRI. Fisher’s exact test and X2 test were used as appropriate; p<0.05 was considered statistically significant.
Results: 348 patients with ARM were enrolled in the study, 147 presented SCA at MRI. 144 patients showed spinal bone anomalies, isolated vertebral and sacral anomalies were found in 17,6% and 35% re- spectively. Higher level of ARM was associated with a significant higher prevalence of sacral and vertebral anoma- lies. A significant correlation was found between the “level” of ARM and the presence of SCA (p<0.05). Sacral anomalies were significantly correlated with the presence of SCA at MRI (p<0.05). SCA were found in 70% of patients with vertebral anomalies (VA) and in 76% of patients with sacral anomalies. The pres- ence of multiple malformations (vertebral and sacral anomalies) are strictly related to the presence of SCA. However, the absence of spinal bone anomalies does not exclude the presence of SCA. SD was the most represented type of SCA (n=94/147), of those 96% had fatty filum. Neurological or neurourological symptoms were detected in 11,5% patients (n=17) with SCA and required neurosurgical intervention. Conclusions: Our data confirm the strong relation between sacral or vertebral anomalies and SCA. How- ever, in our series also patients without sacral/vertebral anomalies had SCA at MRI. Our results sug- gest that, despite the presence or absence of spinal anomalies, spinal cord MRI should be performed in all children with ARM, to allow a correct multidisciplinary follow-up and treatment. In fact, most pa- tients with spinal bone and SCA are asymptomatic, but could develop clinical manifestations during their growth.