Incidence of Tethered Cord in Toe Walking: Single Center Experience at Gillette Children's Specialty Healthcare
Section snippets
Disclosures
Kelly Cho: I Have No Relevant Financial Relationships To Disclose
Objective
The incidence of tethered cord in toe walkers has not been established. Current knowledge of tethered cord in this population is formed by expert opinion; therefore, our objective is to systematically identify the incidence and potential clinical findings that may help clinicians identify tethered cord in toe walkers.
Design
Retrospective cohort study.
Setting
Outpatient pediatric rehabilitation medicine clinic.
Participants
167 patients who presented for toe walking from January 1, 2010 to December 31, 2011.
Interventions
Not Applicable.
Main Outcome Measures
Age of independent ambulation, age when patient first toe walked, percentage of time spent on toes, bowel or bladder changes, complaint of pain or dysesthesias, presence of sacral dimple, Ashworth scores, muscle stretch reflexes, and presence of ankle clonus.
Results
13 patients (7.8%) had spine magnetic resonance imaging (MRI) to rule out tethered cord; of these, one had tethered cord. The factors that led to a spine MRI included pain (76.9%), toe walking starting later than when the child first began to walk (46.2%), bladder incontinence (46.2%), hyperreflexia (38.5%), presence of ankle clonus (38.5%), abnormal muscle tone (30.8%), worsening toe walking (15.4%), and presence of a sacral dimple (15.4%). Interestingly, the child with tethered cord on MRI
Conclusions
In our single-center experience, this study suggests the overall incidence of tethered cord in toe walkers is low (0.6%). Some limitations of this study include selection bias and inability to define a true positive and true false group given only 7.8% of the population had spine MRI. Despite these limitations, we feel our findings are noteworthy and contribute to the lack of data in this area. The frequency of factors that led to the spine MRI and notable finding of scoliosis could be further
Level of Evidence
Level IV