Discussion of Tethered cord
- Tethered spinal cord syndrome a.k.a. occult spinal dysraphism sequence.
- Neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column.
- Caused by spinal open and occult dysraphisms.
- Spinal column develops at greater rate than the spinal cord during fetal development, and abnormal attachments lead to abnormal stretching of the spinal cord.
- Progressive course.
- In children, symptoms may include lesions, hairy patches, dimples, or fatty tumors on the lower back; foot and spinal deformities; weakness in the legs; low back pain; scoliosis; and incontinence.
- May go undiagnosed until adulthood, with development of sensory and motor problems and loss of bowel and bladder control.
- Closely linked to spina bifida.
- Tethering may also develop after spinal cord injury and scar tissue can block the flow of fluids around the spinal cord.
- Fluid pressure may cause cysts to form a syringomyelia. This can lead to additional loss of movement, feeling or the onset of pain or autonomic symptoms.
 Imaging Findings for Tethered cord
- MR useful in visualizing the conus medullaris, assessing the thickness of the filum terminale, identifying traction lesions, and evaluating associated bony dysraphisms.
- In one study of 25 patients (Raghaven, N. et. al.) in 84% the tip of the conus was below the level of the mid-L2 vertebral body.
- Prone imaging may be useful in patients who have undergone tethered cord surgery or in those in whom clinical suspicion is high while supine MR imaging demonstrated no abnormalities.
- Prone MR imaging of little value when supine MR has demonstrated the defect.
- US useful as well: lack of ossification of the posterior arch of the spine in normal infants and the presence of a bony defect in patients with spina bifida permit sonographic examination.
- US may be a useful screening exam.
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 References for Tethered cord
- Raghaven, N., Barkovich, A.J., Edwards, M., and Norman, D. MR imaging in the tethered spinal cord syndrome. Am. J. Roentgen. 1989; 152, 4: 843-852.
- Raghavendra, B.N., Epstein, F.J., Pinto, R.S., Subramanyam, B.R. Greenberg, J., and Mitnick, J.S. The tethered spina cord: diagnosis by high-resolution real-time ultrasound. Radiology. 1983; 149: 123-128.
- Sarwar, M., Virapongse, C., and Bhimani, S. Primary tethered cord syndrome: a new hypothesis of its origin. Am. J. Neurorad. 1984; 5, 3: 235-242.
- Witkamp, T.D. Vandertop, W.P., Beek, F.J.A., Notermans, N.C., Gooskens, R.H.J.M., and van Waes, P.F.G.M.. Medullary cone movement in subjects with a normal spinal cord and in patients with a tethered spinal cord. Radiology 2001; 220: 208-212.