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Journal of Pediatric Neurology 2024; 22(05): 407-418
DOI: 10.1055/s-0044-1788648
Review Article

Malformations of the Spinal Cord: From Genetics to Diagnosis and Rehabilitation

Giovanni Cacciaguerra   *
1   Pediatrics Postgraduate Residency Program, University of Catania, Catania, Italy
,
Federica Dierna   *
1   Pediatrics Postgraduate Residency Program, University of Catania, Catania, Italy
,
Antonio Zanghì   *
2   Research Center for Surgery of Complex Malformation Syndromes of Transition and Adulthood, Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
,
Michele Vecchio
3   Rehabilitation Unit, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
,
Elena R. Praticò
4   Unit of Pediatrics, Carpi Hospital, Carpi, Italy
,
Giuliana La Rosa
5   Department of Medical Surgical Sciences and Advanced Technologies, University Hospital Policlinico “G. Rodolico-San Marco,” Catania, Italy
,
Stefano Palmucci
6   IPTRA Unit, Department of Medical Surgical Sciences and Advanced Technologies, University Hospital Policlinico “G. Rodolico-San Marco,” Catania, Italy
,
Giuseppe Belfiore
7   Unit of Radiology 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia,” University Hospital Policlinico “G. Rodolico-San Marco,” Catania, Italy
,
Antonio Basile
7   Unit of Radiology 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia,” University Hospital Policlinico “G. Rodolico-San Marco,” Catania, Italy
,
Martino Ruggieri
8   Unit of Pediatric Clinic, AOU “Policlinico”, PO “G. Rodolico”, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
,
Agata Polizzi
9   Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
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Abstract

Spinal cord malformations, known as “spinal dysraphisms” encompass a diverse range of spinal abnormalities characterized by incomplete median closure of mesenchymal, bone, and nervous tissues. They are classified as “open,” involving both the spinal cord and overlying tissues, or “occult,” affecting only nervous system structures. Neurulation abnormalities along the neural tube, from the rostral to the caudal portions, primarily cause these malformations. Clinical presentations vary, including cutaneous manifestations like hemangiomas, dimples, hair tufts, and scoliosis. “Tethered cord syndrome,” often associated with these malformations, manifests as a clinical syndrome rather than a primary anomaly. Newborns are typically asymptomatic, with malformations often identified by associated skin abnormalities. Older children may experience pain, sensory/motor disturbances, urinary/anal sphincter abnormalities, and muscle weakness affecting mobility. Neuroimaging, crucial for diagnosis and treatment planning, includes ultrasound, CT, and MRI. Surgical intervention, tailored to specific malformation subtypes, may involve the repair of myelomeningocele soon after birth or conservative management for asymptomatic occult dysraphism. Rehabilitation encompasses physical, occupational, recreational, and speech therapies. Prevention is paramount, emphasizing the role of health care professionals in prenatal care and education. This review aims to provide a systematic classification of spinal cord malformations to aid clinicians in diagnosis and management.

Keywords

spinal cord - malformations - genetics - rehabilitation - diagnosis

* These authors contributed equally to the paper.




Publication History

Received: 28 November 2023

Accepted: 04 April 2024

Article published online:
09 August 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Naidich TP, McLone DG, Harwood-Nash DC. Spinal dysraphysm. In: Newton TH, Potts DG. eds. Modern Neuroradiology, Vol. 1: Computed Tomography of the Spine and Spinal Cord. San Anselmo, CA: Clavadel; 1983: 299-353
    Google Scholar
  • 2 Ruggieri M, Praticò AD, Scuderi A, Sorge G, Polizzi A. The multiple faces of artwork diagnoses. Lancet Neurol 2017; 16 (06) 417-418
    CrossrefPubMedGoogle Scholar
  • 3 French BN. The embryology of spinal dysraphism. Clin Neurosurg 1983; 30: 295-340
    CrossrefPubMedGoogle Scholar
  • 4 Barbagallo M, Ruggieri M, Incorpora G. et al. Infantile spasms in the setting of Sturge-Weber syndrome. Childs Nerv Syst 2009; 25 (01) 111-118
    CrossrefPubMedGoogle Scholar
  • 5 Tortori-Donati P, Rossi A, Cama A. Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology 2000; 42 (07) 471-491
    CrossrefPubMedGoogle Scholar
  • 6 Pavone P, Briuglia S, Falsaperla R. et al. Wide spectrum of congenital anomalies including choanal atresia, malformed extremities, and brain and spinal malformations in a girl with a de novo 5.6-Mb deletion of 13q12.11-13q12.13. Am J Med Genet A 2014; 164A (07) 1734-1743
    CrossrefPubMedGoogle Scholar
  • 7 Anderson FM. Occult spinal dysraphism. Diagnosis and management. J Pediatr 1968; 73 (02) 163-177
    CrossrefPubMedGoogle Scholar
  • 8 Pavone P, Praticò AD, Ruggieri M. et al. Acquired peripheral neuropathy: a report on 20 children. Int J Immunopathol Pharmacol 2012; 25 (02) 513-517
    CrossrefPubMedGoogle Scholar
  • 9 Wallingford JB, Harland RM. Neural tube closure requires Dishevelled-dependent convergent extension of the midline. Development 2002; 129 (24) 5815-5825
    CrossrefPubMedGoogle Scholar
  • 10 Pratico AD, Ruggieri M, Falsaperla R, Pavone P. A probable topiramate-induced limbs paraesthesia and rigid fingers flexion. Curr Drug Saf 2018; 13 (02) 131-136
    CrossrefPubMedGoogle Scholar
  • 11 Pang D, Wilberger Jr JE. Tethered cord syndrome in adults. J Neurosurg 1982; 57 (01) 32-47
    CrossrefPubMedGoogle Scholar
  • 12 Pavone P, Falsaperla R, Ruggieri M. et al. Clinical course of N-methyl-D-aspartate receptor encephalitis and the effectiveness of cyclophosphamide treatment. J Pediatr Neurol 2017; 15: 84-49
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Hoppenfeld S. Congenital kyphosis in myelomeningocele. J Bone Joint Surg Br 1967; 49 (02) 276-280
    CrossrefPubMedGoogle Scholar
  • 14 Pavone P, Nigro F, Falsaperla R. et al. Hemihydranencephaly: living with half brain dysfunction. Ital J Pediatr 2013; 39: 3
    CrossrefPubMedGoogle Scholar
  • 15 Ghi T, Pilu G, Falco P. et al. Prenatal diagnosis of open and closed spina bifida. Ultrasound Obstet Gynecol 2006; 28 (07) 899-903
    CrossrefPubMedGoogle Scholar
  • 16 Falsaperla R, Perciavalle V, Pavone P. et al. Unilateral eye blinking arising from the ictal ipsilateral occipital area. Clin EEG Neurosci 2016; 47 (03) 243-246
    CrossrefPubMedGoogle Scholar
  • 17 Zerah M, Kulkarni AV. Spinal cord malformations. Handb Clin Neurol 2013; 112: 975-991
    CrossrefPubMedGoogle Scholar
  • 18 Pavone P, Praticò AD, Gentile G. et al. A neurocutaneous phenotype with paired hypo- and hyperpigmented macules, microcephaly and stunted growth as prominent features. Eur J Med Genet 2016; 59 (05) 283-289
    CrossrefPubMedGoogle Scholar
  • 19 Emery JL, Lendon RG. The local cord lesion in neurospinal dysraphism (meningomyelocele). J Pathol 1973; 110 (01) 83-96
    CrossrefPubMedGoogle Scholar
  • 20 Ruggieri M, Praticò AD, Caltabiano R, Polizzi A. Rediagnosing one of Smith's patients (John McCann) with “neuromas tumours” (1849). Neurol Sci 2017; 38 (03) 493-499
    CrossrefPubMedGoogle Scholar
  • 21 Duckworth T, Sharrard WJ, Lister J, Seymour N. Hemimyelocele. Dev Med Child Neurol 1968; 10 (suppl 16): 16 , 69
    CrossrefPubMedGoogle Scholar
  • 22 Incorpora G, Pavone P, Castellano-Chiodo D, Praticò AD, Ruggieri M, Pavone L. Gelastic seizures due to hypothalamic hamartoma: rapid resolution after endoscopic tumor disconnection. Neurocase 2013; 19 (05) 458-461
    CrossrefPubMedGoogle Scholar
  • 23 Chakraborty A, Crimmins D, Hayward R, Thompson D. Toward reducing shunt placement rates in patients with myelomeningocele. J Neurosurg Pediatr 2008; 1 (05) 361-365
    CrossrefPubMedGoogle Scholar
  • 24 Vitaliti G, Praticò AD, Cimino C. et al. Hepatitis B vaccine in celiac disease: yesterday, today and tomorrow. World J Gastroenterol 2013; 19 (06) 838-845
    CrossrefPubMedGoogle Scholar
  • 25 McLone DG, Dias MS. Complications of myelomeningocele closure. Pediatr Neurosurg 1991; 17 (05) 267-273
    CrossrefPubMedGoogle Scholar
  • 26 Leonardi S, Praticò AD, Lionetti E, Spina M, Vitaliti G, La Rosa M. Intramuscular vs intradermal route for hepatitis B booster vaccine in celiac children. World J Gastroenterol 2012; 18 (40) 5729-5733
    CrossrefPubMedGoogle Scholar
  • 27 Brunberg JA, DiPietro MA, Venes JL. et al. Intramedullary lesions of the pediatric spinal cord: correlation of findings from MR imaging, intraoperative sonography, surgery, and histologic study. Radiology 1991; 181 (02) 573-579
    CrossrefPubMedGoogle Scholar
  • 28 Vitaliti G, Cimino C, Coco A, Praticò AD, Lionetti E. The immunopathogenesis of cow's milk protein allergy (CMPA). Ital J Pediatr 2012; 38: 35 Erratum in: Ital J Pediatr. 2014;39:82
    CrossrefPubMedGoogle Scholar
  • 29 McLone DG, Knepper PA. The cause of Chiari II malformation: a unified theory. Pediatr Neurosci 1989; 15 (01) 1-12
    CrossrefPubMedGoogle Scholar
  • 30 Palano GM, Praticò AD, Praticò ER. et al. [Accidental ethyl alcohol intoxication in a 30-day-old infant. Clinical findings and neurological follow-up]. Minerva Pediatr 2007; 59 (03) 275-279
    PubMedGoogle Scholar
  • 31 Lode HM, Deeg KH, Krauss J. Spinal sonography in infants with cutaneous birth markers in the lumbo-sacral region–an important sign of occult spinal dysrhaphism and tethered cord. Ultraschall Med 2008; 29 (Suppl. 05) 281-288
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Fiumara A, Lanzafame G, Arena A. et al. COVID-19 Pandemic outbreak and its psychological impact on patients with rare lysosomal diseases. J Clin Med 2020; 9 (09) 2716
    CrossrefPubMedGoogle Scholar
  • 33 Wright RL. 175–191: Congenital dermal sinuses. In: Progress in Neurological Surgery 1971: 4
    Google Scholar
  • 34 Sapuppo A, Pavone P, Praticò AD, Ruggieri M, Bertino G, Fiumara A. Genotype-phenotype variable correlation in Wilson disease: clinical history of two sisters with the similar genotype. BMC Med Genet 2020; 21 (01) 128
    CrossrefPubMedGoogle Scholar
  • 35 Haworth JC, Zachary RB. Congenital dermal sinuses in children; their relation to pilonidal sinuses. Lancet 1955; 269 (6879): 10-14
    CrossrefPubMedGoogle Scholar
  • 36 Praticò AD, Leonardi S. Immunotherapy for food allergies: a myth or a reality?. Immunotherapy 2015; 7 (02) 147-161
    CrossrefPubMedGoogle Scholar
  • 37 Pang D, Dias MS. Cervical myelomeningoceles. Neurosurgery 1993; 33 (03) 363-372 , discussion 372–373
    PubMedGoogle Scholar
  • 38 Salafia S, Praticò AD, Pizzo E, Greco F, Di Bella D. Hemiconvulsion-hemiplegia-epilepsy syndrome. Magnetic resonance findings in a 3-year-old boy. Neurol Neurochir Pol 2013; 47 (06) 584-589
    CrossrefPubMedGoogle Scholar
  • 39 Feltes CH, Fountas KN, Dimopoulos VG. et al. Cervical meningocele in association with spinal abnormalities. Childs Nerv Syst 2003
    PubMedGoogle Scholar
  • 40 Praticò AD, Ruggieri M. COVID-19 vaccination for children: may be necessary for the full eradication of the disease. Pediatr Res 2021; 90 (06) 1102-1103
    CrossrefPubMedGoogle Scholar
  • 41 Sun JCL, Steinbok P, Cochrane DD. Cervical myelocystoceles and meningoceles: long-term follow-up. Pediatr Neurosurg 2000; 33 (03) 118-122
    CrossrefPubMedGoogle Scholar
  • 42 Praticò AD, Mistrello G, La Rosa M. et al. Immunotherapy: a new horizon for egg allergy?. Expert Rev Clin Immunol 2014; 10 (05) 677-686
    CrossrefPubMedGoogle Scholar
  • 43 Leung EC, Sgouros S, Williams S, Johnson K. Spinal lipoma misinterpreted as a meningomyelocele on antenatal MRI scan in a baby girl. Childs Nerv Syst 2002; 18 (6–7): 361-363
    CrossrefPubMedGoogle Scholar
  • 44 Praticò AD. COVID-19 pandemic for Pediatric Health Care: disadvantages and opportunities. Pediatr Res 2021; 89 (04) 709-710
    CrossrefPubMedGoogle Scholar
  • 45 Arai H, Sato K, Okuda O. et al. Surgical experience of 120 patients with lumbosacral lipomas. Acta Neurochir (Wien) 2001; 143 (09) 857-864
    CrossrefPubMedGoogle Scholar
  • 46 Praticò AD, Giallongo A, Arrabito M. et al. SCN2A and its related epileptic phenotypes. J Pediatr Neurol 2023; 21: 173-185
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Pierre-Kahn A, Zerah M, Renier D. et al. Congenital lumbosacral lipomas. Childs Nerv Syst 1997; 13 (06) 298-334 , discussion 335
    CrossrefPubMedGoogle Scholar
  • 48 Praticò AD, Falsaperla R, Comella M, Belfiore G, Polizzi A, Ruggieri M. Case report: A gain-of-function of hamartin may lead to a distinct “inverse TSC1-hamartin” phenotype characterized by reduced cell growth. Front Pediatr 2023; 11: 1101026
    CrossrefPubMedGoogle Scholar
  • 49 McKusick-Nathans Institute for Genetic Medicine, Johns Hopkins University (Baltimore, MD) and National Center For Biotechnology Information, National Library of Medicine (Bethesda, MD). Online Mendelian Inheritance in Man. OMIM™; 2005. Accessed July 9, 2024 at: http://www.ncbi.nlm.nih.gov/omim/
    PubMed
  • 50 Trifiletti RR, Incorpora G, Polizzi A, Cocuzza MD, Bolan EA, Parano E. Aicardi syndrome with multiple tumors: a case report with literature review. Brain Dev 1995; 17 (04) 283-285
    CrossrefPubMedGoogle Scholar
  • 51 Selçuki M, Vatansever S, Inan S, Erdemli E, Bağdatoğlu C, Polat A. Is a filum terminale with a normal appearance really normal?. Childs Nerv Syst 2003; 19 (01) 3-10
    CrossrefPubMedGoogle Scholar
  • 52 Leuzzi V, Mastrangelo M, Polizzi A. et al. Report of two never treated adult sisters with aromatic L-amino acid decarboxylase deficiency: a portrait of the natural history of the disease or an expanding phenotype?. JIMD Rep 2015; 15: 39-45
    PubMedGoogle Scholar
  • 53 Ng WH, Seow WT. Tethered cord syndrome preceding syrinx formation–serial radiological documentation. Childs Nerv Syst 2001; 17 (08) 494-496
    CrossrefPubMedGoogle Scholar
  • 54 Ruggieri M, Polizzi A. From Aldrovandi's “Homuncio” (1592) to Buffon's girl (1749) and the “Wart Man” of Tilesius (1793): antique illustrations of mosaicism in neurofibromatosis?. J Med Genet 2003; 40 (03) 227-232
    CrossrefPubMedGoogle Scholar
  • 55 Rufener SL, Ibrahim M, Raybaud CA, Parmar HA. Congenital spine and spinal cord malformations–pictorial review. AJR Am J Roentgenol 2010; 194 (3 Suppl): S26-S37
    CrossrefPubMedGoogle Scholar
  • 56 Ranieri C, Di Tommaso S, Loconte DC. et al. In vitro efficacy of ARQ 092, an allosteric AKT inhibitor, on primary fibroblast cells derived from patients with PIK3CA-related overgrowth spectrum (PROS). Neurogenetics 2018; 19 (02) 77-91
    CrossrefPubMedGoogle Scholar
  • 57 Unsinn KM, Geley T, Freund MC, Gassner I. US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics 2000; 20 (04) 923-938
    CrossrefPubMedGoogle Scholar
  • 58 Ruggieri M, Pavone P, Polizzi A. et al. Ophthalmological manifestations in segmental neurofibromatosis type 1. Br J Ophthalmol 2004; 88 (11) 1429-1433
    CrossrefPubMedGoogle Scholar
  • 59 Coleman LT, Zimmerman RA, Rorke LB. Ventriculus terminalis of the conus medullaris: MR findings in children. AJNR Am J Neuroradiol 1995; 16 (07) 1421-1426
    PubMedGoogle Scholar
  • 60 O'Connor KC, Lopez-Amaya C, Gagne D. et al. Anti-myelin antibodies modulate clinical expression of childhood multiple sclerosis. J Neuroimmunol 2010; 223 (1–2): 92-99
    CrossrefPubMedGoogle Scholar
  • 61 Källén B, Winberg J. Caudal mesoderm pattern of anomalies: from renal agenesis to sirenomelia. Teratology 1974; 9 (01) 99-111
    CrossrefPubMedGoogle Scholar
  • 62 Ruggieri M, Pavone V, De Luca D, Franzò A, Tiné A, Pavone L. Congenital bone malformations in patients with neurofibromatosis type 1 (Nf1). J Pediatr Orthop 1999; 19 (03) 301-305
    CrossrefPubMedGoogle Scholar
  • 63 Pang D. Sacral agenesis and caudal spinal cord malformations. Neurosurgery 1993; 32 (05) 755-778 , discussion 778–779
    CrossrefPubMedGoogle Scholar
  • 64 Ruggieri M, McShane MA. Parental view of epilepsy in Angelman syndrome: a questionnaire study. Arch Dis Child 1998; 79 (05) 423-426
    CrossrefPubMedGoogle Scholar
  • 65 Passarge E. Congenital malformations and maternal diabetes. Lancet 1965; 1 (7380): 324-325
    CrossrefPubMedGoogle Scholar
  • 66 Ruggieri M, Huson SM. The neurofibromatoses. An overview. Ital J Neurol Sci 1999; 20 (02) 89-108
    CrossrefPubMedGoogle Scholar
  • 67 Nievelstein RAJ, Valk J, Smit LM, Vermeij-Keers C. MR of the caudal regression syndrome: embryologic implications. AJNR Am J Neuroradiol 1994; 15 (06) 1021-1029
    PubMedGoogle Scholar
  • 68 Pratico AD, Longo L, Mansueto S. et al. Off-label use of drugs and adverse drug reactions in pediatric units: a prospective, multicenter study. Curr Drug Saf 2018; 13 (03) 200-207
    CrossrefPubMedGoogle Scholar
  • 69 Barkovich AJ. Normal development of the neonatal and infant brain, skull, and spine. In: Barkovich AJ. ed. Pediatric Neuroimaging. 4th ed.. Philadelphia, PA: Lippincott Williams & Wilkins; 2005: 710 , 723, 732, 735
    Google Scholar
  • 70 Ruggieri M, Polizzi A, Pavone L, Musumeci S. Thalamic syndrome in children with measles infection and selective, reversible thalamic involvement. Pediatrics 1998; 101 (1 Pt 1): 112-119
    CrossrefPubMedGoogle Scholar
  • 71 McLone DG, Naidich TP. Terminal myelocystocele. Neurosurgery 1985; 16 (01) 36-43
    PubMedGoogle Scholar
  • 72 Falsaperla R, Praticò AD, Ruggieri M. et al. Congenital muscular dystrophy: from muscle to brain. Ital J Pediatr 2016; 42 (01) 78
    CrossrefPubMedGoogle Scholar
  • 73 Choi S, McComb JG. Long-term outcome of terminal myelocystocele patients. Pediatr Neurosurg 2000; 32 (02) 86-91
    CrossrefPubMedGoogle Scholar
  • 74 Currarino G, Coln D, Votteler T. Triad of anorectal, sacral, and presacral anomalies. AJR Am J Roentgenol 1981; 137 (02) 395-398
    CrossrefPubMedGoogle Scholar
  • 75 Ashcraft KW, Holder TM. Hereditary presacral teratoma. J Pediatr Surg 1974; 9 (05) 691-697
    CrossrefPubMedGoogle Scholar
  • 76 Lynch SA, Bond PM, Copp AJ. et al. A gene for autosomal dominant sacral agenesis maps to the holoprosencephaly region at 7q36. Nat Genet 1995; 11 (01) 93-95
    CrossrefPubMedGoogle Scholar
  • 77 Ross AJ, Ruiz-Perez V, Wang Y. et al. A homeobox gene, HLXB9, is the major locus for dominantly inherited sacral agenesis. Nat Genet 1998; 20 (04) 358-361
    CrossrefPubMedGoogle Scholar
  • 78 Nagai T, Katoh R, Hasegawa T, Ohashi H, Fukushima Y. Currarino triad (anorectal malformation, sacral bony abnormality and presacral mass) with partial trisomy of chromosomes 13q and 20p. Clin Genet 1994; 45 (05) 272-273
    CrossrefPubMedGoogle Scholar
  • 79 Robin NH, Grace K, DeSouza TG, McDonald-McGinn D, Zackai EH. New finding of Schinzel-Giedion syndrome: a case with a malignant sacrococcygeal teratoma. Am J Med Genet 1993; 47 (06) 852-856
    CrossrefPubMedGoogle Scholar
  • 80 Antich J, Manzanares R, Camarasa F, Krauel X, Vila J, Cusi V. Schinzel-Giedion syndrome: report of two sibs. Am J Med Genet 1995; 59 (01) 96-99
    CrossrefPubMedGoogle Scholar
  • 81 Burrows FGO, Sutcliffe J. The split notochord syndrome. Br J Radiol 1968; 41 (491) 844-847
    CrossrefPubMedGoogle Scholar
  • 82 Paolini S, Ciappetta P, Domenicucci M, Guiducci A. Intramedullary neurenteric cyst with a false mural nodule: case report. Neurosurgery 2003; 52 (01) 243-245 , discussion 246
    PubMedGoogle Scholar
  • 83 Rizk T, Lahoud GA, Maarrawi J. et al. Acute paraplegia revealing an intraspinal neurenteric cyst in a child. Childs Nerv Syst 2001; 17 (12) 754-757
    CrossrefPubMedGoogle Scholar
  • 84 Pang D. Split cord malformation: Part II: Clinical syndrome. Neurosurgery 1992; 31 (03) 481-500
    CrossrefPubMedGoogle Scholar
  • 85 Schijman E. Split spinal cord malformations: report of 22 cases and review of the literature. Childs Nerv Syst 2003; 19 (02) 96-103
    CrossrefPubMedGoogle Scholar
  • 86 Royal SA, Tubbs RS, D'Antonio MG, Rauzzino MJ, Oakes WJ. Investigations into the association between cervicomedullary neuroschisis and mirror movements in patients with Klippel-Feil syndrome. AJNR Am J Neuroradiol 2002; 23 (04) 724-729
    PubMedGoogle Scholar
  • 87 Scott RM, Wolpert SM, Bartoshesky LE, Zimbler S, Karlin L. Segmental spinal dysgenesis. Neurosurgery 1988; 22 (04) 739-744
    CrossrefPubMedGoogle Scholar
  • 88 Tortori-Donati P, Fondelli MP, Rossi A, Raybaud CA, Cama A, Capra V. Segmental spinal dysgenesis: neuroradiologic findings with clinical and embryologic correlation. AJNR Am J Neuroradiol 1999; 20 (03) 445-456
    PubMedGoogle Scholar
  • 89 Chellathurai A, Ayyamperumal B, Thirumaran R, Kathirvelu G, Muthaiyan P, Kannappan S. Segmental spinal dysgenesis– “redefined”. Asian Spine J 2019; 13 (02) 189-197
    CrossrefPubMedGoogle Scholar
  • 90 Bunner R. Lateral intrathoracic meningocele. Acta Radiol 1959; 51 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 91 Petit-Lacour MC, Lasjaunias P, Iffenecker C. et al. Visibility of the central canal on MRI. Neuroradiology 2000; 42 (10) 756-761
    CrossrefPubMedGoogle Scholar
  • 92 Gardner WJ. Hydrodynamic mechanism of syringomyelia: its relationship to myelocele. J Neurol Neurosurg Psychiatry 1965; 28 (03) 247-259
    CrossrefPubMedGoogle Scholar
  • 93 Alamdaran SA, Mohammadpanah N, Zabihian S, Esmaeeli M, Ghane F, Feyzi A. Diagnostic value of ultrasonography in spinal abnormalities among children with neurogenic bladder. Electron Physician 2017; 9 (06) 4571-4576
    CrossrefPubMedGoogle Scholar
  • 94 Akalan N. Myelomeningocele (open spina bifida) - surgical management. Adv Tech Stand Neurosurg 2011; (37) 113-141
    CrossrefPubMedGoogle Scholar
  • 95 Floresta G, Patamia V, Gentile D. et al. Repurposing of FDA-approved drugs for treating iatrogenic botulism: a paired 3D-QSAR/docking approach† . ChemMedChem 2020; 15 (02) 256-262
    CrossrefPubMedGoogle Scholar
  • 96 Gentile D, Floresta G, Patamia V. et al. An Integrated Pharmacophore/Docking/3D-QSAR approach to screening a large library of products in search of future botulinum neurotoxin A inhibitors. Int J Mol Sci 2020; 21 (24) 9470
    CrossrefPubMedGoogle Scholar
  • 97 Vecchio M, Gracies JM, Panza F. et al. Change in coefficient of fatigability following rapid, repetitive movement training in post-stroke spastic paresis: a prospective open-label observational study. J Stroke Cerebrovasc Dis 2017; 26 (11) 2536-2540
    CrossrefPubMedGoogle Scholar
  • 98 Santamato A, Ranieri M, Solfrizzi V. et al. High doses of incobotulinum toxin A for the treatment of post-stroke spasticity: are they safe and effective?. Expert Opin Drug Metab Toxicol 2016; 12 (08) 843-846
    CrossrefPubMedGoogle Scholar