Objective
It is controversial to decide whether to operate in an asymptomatic patient especially in infants who are suspected spinal bifida occulta which does not expose the spinal cord or meninges outward. However, skin lesions such as dimple, hemangioma, lipoma, bleaching, hyperplasia, and cigarette burn scar could be shown at birth. Although other lower limb weakness, foot deformity, and bladder/bowel dysfunction can be shown, the infant patients often have not progressed much and their clinical presentation is not clear, making it difficult to determine the necessity of the surgery. The purpose of this study is to verify whether the electromyographic evaluation can screen neural damage in an infant who is suspected of spinal bifida.
Methods
A retrospective study, from December 2018 to October 2019, was conducted. The study sample comprised patients conducting electromyography for suspected spinal bifida before twelve months of the birth. The medical records of the infant were reviewed to investigate the clinical presentation, laboratory results such as urodynamic study and surgery status.
Results
Overall, 55 infants were included in this study. The average age of the first electromyography for the suspicion of Spinal Bifida was 134days form the birth. The major symptoms of visiting the pediatric neurosurgery department were mainly skin problems, followed by dimple 32 (58.2%), lumbosacral mass 8 (14.6%), skin tag 5 (9.1%), and cigarette burn scar (3.6%). Foot deformity was found in two (3.6%) and both underwent surgery.
Nerve conduction study and needle electromyography (NCS/EMG) was safely done in all 55 of infants. And 41 (74.6%) of them also underwent a urodynamic study to check bladder and urethral dysfunction. The 11 infants (26.8%) showed abnormalities corresponding to neurogenic bladder.
According to the NCS/EMG records, the 31 infants (56.4%) showed abnormal findings corresponding to radiculopathy with denervation potential, and 19 (61.3%) were accompanied by morphological changes in motor unit action potentials. Of the 31 infants who found EMG abnormalities, 28 underwent surgery, and the other 3 also recommended surgical procedure, but one could not be operated due to other medical conditions, and two were follow-up lost. In the operated group, there were 67.9% of the cases where abnormalities were found only in electromyographic evaluation without any other symptoms.
Conclusions
It is not easy to discover the presence of lower limb or bladder dysfunction in infants using physical examination and urodynamic study. Electromyography could be an important aid in determining the necessity of surgical procedures in an asymptomatic infant. Further investigations are needed to provide a statistically significant level of evidence. |
