{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T13:11:13Z","timestamp":1785244273365,"version":"3.55.0"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T00:00:00Z","timestamp":1741305600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T00:00:00Z","timestamp":1741305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004823","name":"Nagoya University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004823","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Anesth"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>Tethered cord syndrome (TCS) can be detected on spinal ultrasound (s-US) performed by anesthesiologists immediately prior to caudal epidural block. In such cases, neurosurgical consultation should be considered to ensure timely diagnosis and treatment. This study aimed to describe: (1) the frequency of TCS requiring surgery in pediatric urological cases with sacral dimples following neurosurgical consultation; (2) the sacral dimple morphology indicative of TCS; and (3) filum terminale thickness as a predictor of TCS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This retrospective, single-center, descriptive study included children\u2009\u2264\u20093\u00a0years old with sacral dimples undergoing their first urological surgery with caudal epidural block between April 2019 and June 2024. We described: (1) the proportion of cases requiring spinal surgery based on s-US and postoperative magnetic resonance imaging (MRI); (2) differences in the proportions of patients with dimple long diameter\u2009\u2265\u20095\u00a0mm and distance from anal margin\u2009\u2265\u200925\u00a0mm between TCS and non-TCS cases; and (3) the optimal filum terminale thickness for predicting TCS using receiver operating characteristic curve analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Among 130\u00a0patients analyzed, 6 (4.6%) underwent tethered cord release surgery based on abnormal findings from s-US and postoperative MRI. A significant difference in the proportion of patients with dimple long diameter\u2009\u2265\u20095\u00a0mm was identified between TCS and non-TCS cases (<jats:italic>p<\/jats:italic>\u2009=\u20090.046). A cutoff filum terminale thickness\u2009\u2265\u20091.3\u00a0mm yielded a Youden index of 0.73, with 93% sensitivity and 80% specificity for detecting filum terminale lipoma.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Spinal ultrasonography and dimple size may help to identify underlying TCS.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00540-025-03478-x","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T11:24:18Z","timestamp":1741346658000},"page":"400-407","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of spinal ultrasonography just before caudal epidural block for identifying tethered cord syndrome in urological cases with sacral dimples: a retrospective descriptive study"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7815-7185","authenticated-orcid":false,"given":"Fumio","family":"Watanabe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiki","family":"Kojima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsunori","family":"Miyazu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Kitoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,7]]},"reference":[{"issue":"6","key":"3478_CR1","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1097\/ALN.0000000000004899","volume":"140","author":"R Eizaga Rebollar","year":"2024","unstructured":"Eizaga Rebollar R, Carnota Mart\u00edn AI, Borreiros Rodr\u00edguez E, Rojo DR. Tethered spinal cord syndrome discovered during ultrasound-guided caudal block. Anesthesiology. 2024;140(6):1203\u20134.","journal-title":"Anesthesiology"},{"key":"3478_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2021.110446","volume":"74","author":"F Watanabe","year":"2021","unstructured":"Watanabe F, Miyazu M, Kojima T. Introduction of convenient conus to coccyx point-of-care ultrasound (C3PO) in children with a sacral dimple. J Clin Anesth. 2021;74: 110446.","journal-title":"J Clin Anesth"},{"issue":"2","key":"3478_CR3","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/s00381-017-3638-0","volume":"34","author":"E Ausili","year":"2018","unstructured":"Ausili E, Maresca G, Massimi L, Morgante L, Romagnoli C, Rendeli C. Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging. Childs Nerv Syst. 2018;34(2):285\u201391.","journal-title":"Childs Nerv Syst"},{"issue":"1","key":"3478_CR4","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1002\/ajmg.1320520103","volume":"52","author":"ML Mart\u00ednez-Fr\u00edas","year":"1994","unstructured":"Mart\u00ednez-Fr\u00edas ML. Spina bifida and hypospadias: a non-random association or an X-linked recessive condition? Am J Med Genet. 1994;52(1):5\u20138.","journal-title":"Am J Med Genet"},{"issue":"4","key":"3478_CR5","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.bja.2018.11.030","volume":"122","author":"M Wiegele","year":"2019","unstructured":"Wiegele M, Marhofer P, L\u00f6nnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019;122(4):509\u201317. https:\/\/doi.org\/10.1016\/j.bja.2018.11.030. (Epub 2019 Feb 1. PMID: 30857607; PMCID: PMC6435837).","journal-title":"Br J Anaesth"},{"issue":"6","key":"3478_CR6","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.2214\/ajr.171.6.9843314","volume":"171","author":"VM Kriss","year":"1998","unstructured":"Kriss VM, Desai NS. Occult spinal dysraphism in neonates: assessment of high-risk cutaneous stigmata on sonography. AJR Am J Roentgenol. 1998;171(6):1687\u201392.","journal-title":"AJR Am J Roentgenol"},{"issue":"11","key":"3478_CR7","doi-asserted-by":"publisher","first-page":"1943","DOI":"10.7863\/ultra.14.10079","volume":"34","author":"HJ Shin","year":"2015","unstructured":"Shin HJ, Kim MJ, Lee HS, Kim HG, Lee MJ. Optimal filum terminale thickness cutoff value on sonography for lipoma screening in young children. J Ultrasound Med. 2015;34(11):1943\u20139. https:\/\/doi.org\/10.7863\/ultra.14.10079. (Epub 2015 Sep 18 PMID: 26384611).","journal-title":"J Ultrasound Med"},{"issue":"1","key":"3478_CR8","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1080\/10543406.2019.1632876","volume":"30","author":"J Hua","year":"2020","unstructured":"Hua J, Tian L. A comprehensive and comparative review of optimal cut-points selection methods for diseases with multiple ordinal stages. J Biopharm Stat. 2020;30(1):46\u201368. https:\/\/doi.org\/10.1080\/10543406.2019.1632876. (Epub 2019 Jun 28 PMID: 31250693).","journal-title":"J Biopharm Stat"},{"issue":"3","key":"3478_CR9","doi-asserted-by":"publisher","first-page":"274","DOI":"10.3171\/2011.12.PEDS11351","volume":"9","author":"JJ Chern","year":"2012","unstructured":"Chern JJ, Kirkman JL, Shannon CN, Tubbs RS, Stone JD, Royal SA, Oakes WJ, Rozzelle CJ, Wellons JC. Use of lumbar ultrasonography to detect occult spinal dysraphism. 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Ultrasonography. 2020;39(4):367\u201375.","journal-title":"Ultrasonography"},{"issue":"7","key":"3478_CR12","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1111\/j.1460-9592.2011.03702.x","volume":"22","author":"P Kundra","year":"2012","unstructured":"Kundra P, Yuvaraj K, Agrawal K, Krishnappa S, Kumar LT. Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block. Paediatr Anaesth. 2012;22(7):707\u201312.","journal-title":"Paediatr Anaesth"},{"issue":"3","key":"3478_CR13","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.jpurol.2023.02.005","volume":"19","author":"S Anand","year":"2023","unstructured":"Anand S, Braga LH. Fragility index of meta-analyses and randomized-controlled trials on the efficacy of caudal block for hypospadias: is the glass half-full or half-empty? J Pediatr Urol. 2023;19(3):359\u201360.","journal-title":"J Pediatr Urol"},{"issue":"1","key":"3478_CR14","doi-asserted-by":"publisher","first-page":"59.e1","DOI":"10.1016\/j.jpurol.2021.11.009","volume":"18","author":"F Alizadeh","year":"2022","unstructured":"Alizadeh F, Amraei M, Haghdani S, Honarmand A. The effect of caudal epidural block on the surgical complications of hypospadias repair in children aged 6 to 35 months: a randomized controlled trial. J Pediatr Urol. 2022;18(1):59.e1-6.","journal-title":"J Pediatr Urol"}],"container-title":["Journal of Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00540-025-03478-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00540-025-03478-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00540-025-03478-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T18:31:00Z","timestamp":1748111460000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00540-025-03478-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,7]]},"references-count":14,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["3478"],"URL":"https:\/\/doi.org\/10.1007\/s00540-025-03478-x","relation":{},"ISSN":["0913-8668","1438-8359"],"issn-type":[{"value":"0913-8668","type":"print"},{"value":"1438-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,7]]},"assertion":[{"value":"21 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 February 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the institutional ethics committee at Aichi Children\u2019s Health and Medical Center (approval no. 2024023; date of approval: 1 July 2024).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The requirement for written consent was waived by the institutional ethics committee based on the retrospective nature of this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}