Tethered cord in patients affected by anorectal malformations: a survey from the ARM-Net Consortium

María Fanjul, I. Samuk, P. Bagolan, Ernesto Leva, C. Sloots, C. Giné, Dalia Aminoff, Paola Midrio, Dalia Aminoff, Piero Bagolan, Ivo De Blaauw, Stefan Deluggi, María Fanjul, Francesco Fascetti Leon, Araceli García, Carles Giné, Stefano Giuliani, Caterina Grano, Sabine Grasshoff-Derr, Michel HaanenStephan Holland-Cunz, Ekkehart Jenetzky, Martin Lacher, Ernesto Leva, Grabiele Lisi, Igor Makedonsky, Carlos Marcelis, Paola Midrio, Marc Miserez, Onur Ozen, Ferda Percin, Heiko Reutter, Stephan Rohleder, Inbal Samuk, Eberhard Schmiedeke, Nicole Schwarzer, Pim Sloots, Pernilla Stenström, Holger Till, Lideke Van der Steeg, Iris Van Rooij, Patrick Volk, Tomas Wester, Nadine Zwink, On behalf of the ARM-Net Consortium

Research output: Contribution to journalArticlepeer-review


Purpose: The goal of this study was to determine the degree of consensus in the management of spinal cord tethering (TC) in patients with anorectal malformation (ARM) in a large cohort of European pediatric centers. Methods: A survey was sent to pediatric surgeons (one per center) members of the ARM-Net Consortium. Results: Twenty-four (86%) from ten different countries completed the survey. Overall prevalence of TC was: 21% unknown, 46% below 15, and 29% between 15 and 30%. Ninety-six agreed on screening all patients for TC regardless the type of ARM and 79% start screening at birth. Responses varied in TC definition and diagnostic tools. Fifty percent of respondents prefer ultrasound (US), 21% indicate either US or magnetic resonance (MRI) based on a pre-defined risk of presenting TC, and 21% perform both. Discrepancy exists in complementary test: 82% carry out urodynamic studies (UDS) and only 37% perform somatosensory-evoked potentials (SSEP). Prophylactic untethering is performed in only two centers (8%). Conclusions: Survey results support TC screening in all patients with ARM and conservative management of TC. There is discrepancy in the definition of TC, screening tools, and complementary test. Protocols should be developed to avoid such variability in management.

Original languageEnglish
Pages (from-to)849-854
Number of pages6
JournalPediatric Surgery International
Issue number8
Publication statusPublished - Aug 1 2017


  • Anorectal malformation
  • Arm-Net Consortium
  • Neurosurgery
  • Tethered cord

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


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