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Electrodiagnostic findings of retethering in children with spinal dysraphism

  • Original Article - Pediatric Neurosurgery
  • Published:
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Abstract

Purpose

Retethering of the cord can occur after the initial untethering surgery. Typical neurological manifestations indicative of cord tethering are often difficult to determine in pediatric patients. Patients who had a primary untethering operation are likely to present with some degree of neurological deficits from a previous tethering event, and urodynamic studies (UDSs) and spine images are frequently abnormal. Therefore, more objective tools to detect retethering are needed. This study sought to delineate the characteristics of EDS of retethering, and therefore, could support the diagnosis of retethering.

Methods

Among 692 subjects who had an untethering operation, data from 93 subjects who had been suspected of retethering clinically were retrospectively extracted. The subjects were divided into two groups, a retethered group, and a non-progression group, according to whether or not surgical interventions had been performed. Two consecutive EDSs, clinical findings, spine magnetic resonance imaging scans, and UDSs before the development of new tethering symptoms were reviewed and compared.

Results

In the electromyography (EMG) study, the appearance of abnormal spontaneous activity (ASA) in new muscles was prominent in the retethered group (p < 0.01). The loss of ASA was more pronounced in the non-progression group (p < 0.01). Specificity and sensitivity of EMG for retethering were 80.4 and 56.5%, respectively. In the nerve conduction study, the two groups did not show differences. The size of fibrillation potential was not different between the groups.

Conclusions

To provide support for a clinician’s decision on retethering, EDS could be an advantageous tool with high specificity when the results are compared to previous EDS results. Routine follow-up EDS post-operatively is recommended as a baseline for comparison at the time when retethering is clinically suspected.

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Data Availability

The datasets from the current study are not publicly available because it is used for further analysis, but are available from the corresponding author on reasonable request.

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Authors and Affiliations

Authors

Contributions

HIS1 and HIS2 contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by HIS1, HIS2, and KHK. The first draft of the manuscript was written by HIS1 and HIS2 and reviewed by KCW and JYL. All authors read and approved the final manuscript (HIS1, Hyun Iee Shin; HIS2, Hyung-Ik Shin).

Corresponding author

Correspondence to Hyung-Ik Shin.

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Ethical standards

The study protocol was approved by the institutional review board (IRB no. 1812–054-993) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

The authors declare no competing interests.

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This article is part of the Topical Collection on Pediatric Neurosurgery

Hyun Iee Shin is the first author, and Kyu-Chang Wang, Ji Yeoun Lee, and Kyung Hyun Kim are co-authors.

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Shin, H.I., Wang, KC., Lee, J.Y. et al. Electrodiagnostic findings of retethering in children with spinal dysraphism. Acta Neurochir 165, 915–925 (2023). https://doi.org/10.1007/s00701-023-05539-0

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  • DOI: https://doi.org/10.1007/s00701-023-05539-0

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