Introduction The association between anorectal malformations and spinal cord tethering (TC) has been well recognized. Untethering of the cord is generally indicated in patients with progressive/new onset of symptoms attributed to TC. Yet, there is controversy regarding the management of asymptomatic TC.
Aim:to find the incidence of TC in ARM patients and to determine the relationship between bowel/urinary control and TC in a subset of patients with rectobladder neck fistula(RBNF).
Methods The database of a tertiary medical center was retrospectively reviewed for all patients treated for ARM from 1980-2012. All patients with TC and RBNF were identified. Data were collected by chart review.
Results Among 790 patients, who underwent screening for TC, 285(36%), were radiological diagnosed with TC. Eleven of 37 screened patients with RBNF were diagnosed with TC. The median follow up period was 49 months (range 2-222 months). TC was diagnosed in 3/18(16.6%) patients with sacral ratio (SR) ≥0.7; 4/12(33.3%) with SR 0.41–0.69; and 4/7 (57.1%) patients with SR 0–0.4. The association of TC in RBNF patients further reduced prognosis for bowel and urinary control.
Conclusion: The incidence of TC among patients with ARM is 36% and is higher the more complex the malformation. Incidence of TC among patients with RBNF correlates with SR value and is higher the lower the SR. Patients with RBNF and TC have dismal prognosis for bowel control, unrelated to their SR status. Many unresolved questions related to the management of ARM patients with asymptomatic TC, still remain.
