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Purpose <p>Tethered cord syndrome (TCS) can be detected on spinal ultrasound (s-US) performed by anesthesiologists immediately prior to caudal epidural block. In such cases, neurosurgical consultation should be considered to ensure timely diagnosis and treatment. This study aimed to describe: (1) the frequency of TCS requiring surgery in pediatric urological cases with sacral dimples following neurosurgical consultation; (2) the sacral dimple morphology indicative of TCS; and (3) filum terminale thickness as a predictor of TCS.</p> Methods <p>This retrospective, single-center, descriptive study included children ≤ 3&#xa0;years old with sacral dimples undergoing their first urological surgery with caudal epidural block between April 2019 and June 2024. We described: (1) the proportion of cases requiring spinal surgery based on s-US and postoperative magnetic resonance imaging (MRI); (2) differences in the proportions of patients with dimple long diameter ≥ 5&#xa0;mm and distance from anal margin ≥ 25&#xa0;mm between TCS and non-TCS cases; and (3) the optimal filum terminale thickness for predicting TCS using receiver operating characteristic curve analysis.</p> Results <p>Among 130&#xa0;patients analyzed, 6 (4.6%) underwent tethered cord release surgery based on abnormal findings from s-US and postoperative MRI. A significant difference in the proportion of patients with dimple long diameter ≥ 5&#xa0;mm was identified between TCS and non-TCS cases (<i>p</i> = 0.046). A cutoff filum terminale thickness ≥ 1.3&#xa0;mm yielded a Youden index of 0.73, with 93% sensitivity and 80% specificity for detecting filum terminale lipoma.</p> Conclusion <p>Spinal ultrasonography and dimple size may help to identify underlying TCS.</p>

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Efficacy of spinal ultrasonography just before caudal epidural block for identifying tethered cord syndrome in urological cases with sacral dimples: a retrospective descriptive study

  • 期刊论文

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  • 发表日期：

    2025年3月7日

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  • Fumio Watanabe,
  • Taiki Kojima,
  • Mitsunori Miyazu,
  • Hiroshi Kitoh

摘要

Purpose

Tethered cord syndrome (TCS) can be detected on spinal ultrasound (s-US) performed by anesthesiologists immediately prior to caudal epidural block. In such cases, neurosurgical consultation should be considered to ensure timely diagnosis and treatment. This study aimed to describe: (1) the frequency of TCS requiring surgery in pediatric urological cases with sacral dimples following neurosurgical consultation; (2) the sacral dimple morphology indicative of TCS; and (3) filum terminale thickness as a predictor of TCS.

Methods

This retrospective, single-center, descriptive study included children ≤ 3 years old with sacral dimples undergoing their first urological surgery with caudal epidural block between April 2019 and June 2024. We described: (1) the proportion of cases requiring spinal surgery based on s-US and postoperative magnetic resonance imaging (MRI); (2) differences in the proportions of patients with dimple long diameter ≥ 5 mm and distance from anal margin ≥ 25 mm between TCS and non-TCS cases; and (3) the optimal filum terminale thickness for predicting TCS using receiver operating characteristic curve analysis.

Results

Among 130 patients analyzed, 6 (4.6%) underwent tethered cord release surgery based on abnormal findings from s-US and postoperative MRI. A significant difference in the proportion of patients with dimple long diameter ≥ 5 mm was identified between TCS and non-TCS cases (p = 0.046). A cutoff filum terminale thickness ≥ 1.3 mm yielded a Youden index of 0.73, with 93% sensitivity and 80% specificity for detecting filum terminale lipoma.

Conclusion

Spinal ultrasonography and dimple size may help to identify underlying TCS.