Our Summary

This research paper is about investigating the use of MRI scans to diagnose children who walk on their toes, a condition often referred to as toe walking. This was done at a single hospital over five years, with 118 children who were diagnosed with toe walking undergoing these scans.

The researchers were looking for major and minor abnormalities in the scans. Major abnormalities were those that clearly pointed to a problem with the spine, such as a tethered cord, while minor abnormalities were those that could not be directly linked to toe walking.

They found that 25% of the children showed major abnormalities in their scans, while 19% showed minor abnormalities. More than half (56%) of the children had normal scans.

The study found that children who started toe walking late were more likely to have major abnormalities in their scans. However, other symptoms like abnormal reflexes, severe muscle contractions, back pain, bladder incontinence, and not improving with standard treatment did not make it more likely to find a major abnormality in the scans.

The study also found that 25% of the children had to undergo surgery to lengthen their tendons, while 4% needed neurosurgery, most commonly to fix a tethered spinal cord.

In conclusion, the research suggests that MRI scans can be useful in diagnosing children who toe walk, especially if they started toe walking late. Therefore, the authors suggest that doctors should consider ordering an MRI scan for children with late-onset toe walking.

FAQs

  1. What percentage of children in the study showed major and minor abnormalities in their MRI scans respectively?
  2. Are there additional symptoms that make it more likely to find a major abnormality in the scans?
  3. What types of surgery did the children in the study have to undergo and how common were they?

Doctor’s Tip

A helpful tip a doctor might tell a patient about detethering surgery is to follow post-operative instructions carefully to ensure proper healing and recovery. This may include restrictions on physical activity, proper wound care, and attending follow-up appointments with the surgeon. It is important to communicate any concerns or changes in symptoms to the healthcare provider to ensure the best possible outcome after detethering surgery.

Suitable For

Patients who are typically recommended detethering surgery are those who have been diagnosed with a tethered spinal cord, which is a major abnormality that can be identified through MRI scans. In this study, children who started toe walking late were more likely to have major abnormalities in their scans, indicating that this subgroup of patients may benefit from detethering surgery.

Additionally, patients who have other symptoms such as abnormal reflexes, severe muscle contractions, back pain, bladder incontinence, and not improving with standard treatment may also be recommended for detethering surgery if a tethered spinal cord is identified as the underlying cause of their toe walking.

Overall, the findings of this study suggest that MRI scans can play an important role in diagnosing children who walk on their toes, particularly in identifying major abnormalities such as a tethered spinal cord that may require surgical intervention. Therefore, patients who present with late-onset toe walking and other concerning symptoms should be considered for MRI scans and potentially detethering surgery to address any underlying spinal cord abnormalities.

Timeline

Before detethering surgery:

  1. Child is diagnosed with toe walking after exhibiting the behavior for some time.
  2. Doctor recommends further evaluation, including MRI scans to determine the cause of the toe walking.
  3. MRI scans are performed to look for major and minor abnormalities in the spine.
  4. Results of the MRI scans show whether there are any abnormalities that could be causing the toe walking.
  5. Depending on the findings, a treatment plan is developed which may include surgery to correct any spinal abnormalities.

After detethering surgery:

  1. Child undergoes detethering surgery to correct any spinal abnormalities that may be causing the toe walking.
  2. Recovery period post-surgery, which may include physical therapy and rehabilitation.
  3. Child gradually resumes normal activities and hopefully stops toe walking.
  4. Follow-up appointments with the doctor to monitor progress and ensure that the surgery was successful in correcting the issue.
  5. Continued monitoring for any recurrence of toe walking or other symptoms that may indicate a need for further intervention.

What to Ask Your Doctor

Some questions a patient should ask their doctor about detethering surgery include:

  1. What is a tethered spinal cord and how does it relate to toe walking?
  2. What are the potential risks and benefits of detethering surgery?
  3. How do I know if I am a candidate for detethering surgery?
  4. What is the success rate of detethering surgery in resolving toe walking?
  5. What is the recovery process like after detethering surgery?
  6. Are there any alternative treatments or therapies for toe walking that I should consider before opting for surgery?
  7. How long will it take for me to see improvements in my toe walking after surgery?
  8. Are there any long-term effects or complications associated with detethering surgery?
  9. How many detethering surgeries have you performed and what is your success rate?
  10. Are there any specific lifestyle changes or precautions I should take after undergoing detethering surgery?

Reference

Authors: Flaugh RA, May CJ, Curran P, Miller PE, Kasser JR, Shore BJ. Journal: J Pediatr Orthop. 2024 Apr 1;44(4):267-272. doi: 10.1097/BPO.0000000000002633. Epub 2024 Feb 2. PMID: 38299252