Shields Lisa Be, Mutchnick Ian S, Daniels Michael W, Peppas Dennis S, Rosenberg Eran
Norton Neuroscience Institute, Norton Healthcare, Louisville, KY, USA.
Department of Bioinformatics & Biostatistics, University of Louisville, Louisville, KY, USA.
SAGE Open Med. 2021 Aug 4;9:20503121211037172. doi: 10.1177/20503121211037172. eCollection 2021.
Occult spinal dysraphism is a congenital failure of fusion of the posterior vertebral arches with intact skin overlying the defect. Lumbosacral cutaneous manifestations are associated with a variable risk of occult spinal dysraphism. Tethered cord syndrome is a type of occult spinal dysraphism that puts abnormal traction on the spinal cord. This study analyzed neonates and infants who were referred to our pediatric urology practice and had evidence of lumbosacral cutaneous manifestation on physical examination.
We reviewed the presence of lumbosacral cutaneous manifestations in neonates and infants evaluated in our pediatric urology clinic at our Institution over a 6-year period (1 March, 2015-28 February, 2021) with no prior diagnosis of lumbosacral cutaneous manifestation. All patients underwent a spinal ultrasound.
The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. A coccygeal pit was statistically marginally higher in abnormal versus normal spinal ultrasound (p = 0.07). Patients with only one lumbosacral cutaneous manifestation (N = 121) were significantly more likely to have a normal spinal ultrasound compared to those with two or more lumbosacral cutaneous manifestation (N = 17) (79% vs 53%, p = 0.03).
Due to the varying risk of certain lumbosacral cutaneous manifestations with occult spinal dysraphism, all patients with a lumbosacral cutaneous manifestation should undergo spinal ultrasound. This study also highlights the importance of urodynamic studies when there are abnormal cutaneous findings. Routine physical examinations of the lumbar region for cutaneous manifestations of occult spinal dysraphism are vital to ensure prompt management of tethered cord syndrome and avoid potentially devastating consequences.
隐性脊柱裂是后椎弓融合先天性失败，缺损上方皮肤完整。腰骶部皮肤表现与隐性脊柱裂的风险各异相关。脊髓拴系综合征是隐性脊柱裂的一种类型，会对脊髓施加异常牵引力。本研究分析了转诊至我们儿科泌尿外科且体格检查有腰骶部皮肤表现证据的新生儿和婴儿。
我们回顾了在我们机构儿科泌尿外科诊所6年期间（2015年3月1日至2021年2月28日）评估的新生儿和婴儿中腰骶部皮肤表现的情况，这些患儿此前未被诊断为腰骶部皮肤表现。所有患者均接受了脊柱超声检查。
最常见的腰骶部皮肤表现为臀沟分叉/重复（33%）、臀部不对称（19%）和骶部酒窝（14%）。共有34例（24%）患者脊柱超声异常；其中15例（44%）婴儿接受了腰椎磁共振成像检查。尾骨窝在脊柱超声异常组与正常组中的发生率在统计学上略高（p = 0.07）。与有两种或更多腰骶部皮肤表现的患者（N = 17）相比，仅有一种腰骶部皮肤表现的患者（N = 121）脊柱超声正常的可能性显著更高（79%对53%，p = 0.03）。
由于某些腰骶部皮肤表现与隐性脊柱裂的风险不同，所有有腰骶部皮肤表现的患者均应接受脊柱超声检查。本研究还强调了在皮肤检查结果异常时进行尿动力学研究的重要性。对腰椎区域进行隐性脊柱裂皮肤表现的常规体格检查对于确保及时处理脊髓拴系综合征和避免潜在的严重后果至关重要。
Zotero 插件