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Tethered Spinal Cord
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Tethered cord syndrome (TCS), tight filum terminale syndrome (TFTS)
              • Definitions

                • Symptoms and imaging findings related to low-lying conus medullaris tethered by short, thick filum terminale

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Kucera JN et al: The simple sacral dimple: diagnostic yield of ultrasound in neonates. Pediatr Radiol. ePub, 2014
                                              2. Scottoni F et al: Spinal ultrasound in patients with anorectal malformations: is this the end of an era? Pediatr Surg Int. ePub, 2014
                                              3. Al-Holou WN et al: The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome. J Neurosurg Pediatr. 4(1):28-36, 2009
                                              4. Bauer DF et al: Study of the effects of flexion on the position of the conus medullaris: follow-up study using MR imaging in non-human primates. Childs Nerv Syst. 25(8):977-9, 2009
                                              5. Ben-Sira L et al: Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr. 155(6):864-9, 2009
                                              6. Hsu AR et al: Resolution of syringomyelia after release of tethered cord. Surg Neurol. Epub ahead of print, 2009
                                              7. Husain AM et al: Prognostic value of neurophysiologic intraoperative monitoring in tethered cord syndrome surgery. J Clin Neurophysiol. 26(4):244-7, 2009
                                              8. McGirt MJ et al: Pediatric tethered cord syndrome: response of scoliosis to untethering procedures. Clinical article. J Neurosurg Pediatr. 4(3):270-4, 2009
                                              9. Aufschnaiter K et al: Surgery in adult onset tethered cord syndrome (ATCS): review of literature on occasion of an exceptional case. Neurosurg Rev. 31(4):371-83; discussion 384, 2008
                                              10. Bauer DF et al: Study of the effects of flexion on the position of the conus medullaris. Childs Nerv Syst. 24(9):1043-5, 2008
                                              11. Caird J et al: Significant clinical and radiological resolution of a spinal cord syrinx following the release of a tethered cord in a patient with an anatomically normal conus medullaris. Case report. J Neurosurg Pediatr. 1(5):396-8, 2008
                                              12. Deeg KH et al: Spinal sonography in newborns and infants - part II: spinal dysraphism and tethered cord. Ultraschall Med. 29(1):77-88, 2008
                                              13. Düz B et al: Tethered cord syndrome in adulthood. J Spinal Cord Med. 31(3):272-8, 2008
                                              14. Skeik N et al: Intermittent back and leg pain with numbness. Tethered spinal cord syndrome. Am Fam Physician. 78(7):869-70, 2008
                                              15. Agarwalla PK et al: Tethered cord syndrome. Neurosurg Clin N Am. 18(3):531-47, 2007
                                              16. Bao N et al: Tight filum terminale syndrome in children: analysis based on positioning of the conus and absence or presence of lumbosacral lipoma. Childs Nerv Syst. 23(10):1129-34, 2007
                                              17. Bui CJ et al: Tethered cord syndrome in children: a review. Neurosurg Focus. 23(2):1-9, 2007
                                              18. Hajnovic L et al: Tethered spinal cord syndrome--the importance of time for outcomes. Eur J Pediatr Surg. 17(3):190-3, 2007
                                              19. Lad SP et al: Tethered cord syndrome: nationwide inpatient complications and outcomes. Neurosurg Focus. 23(2):1-5, 2007
                                              20. Lew SM et al: Tethered cord syndrome: an updated review. Pediatr Neurosurg. 43(3):236-48, 2007
                                              21. Selden NR: Minimal tethered cord syndrome: what's necessary to justify a new surgical indication? Neurosurg Focus. 23(2):1-5, 2007
                                              22. Yamada S et al: Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg Focus. 23(2):1-10, 2007
                                              23. Yamada S et al: What is the true tethered cord syndrome? Childs Nerv Syst. 23(4):371-5, 2007
                                              24. Drake JM: Occult tethered cord syndrome: not an indication for surgery. J Neurosurg. 104(5 Suppl):305-8, 2006
                                              25. Selden NR: Occult tethered cord syndrome: the case for surgery. J Neurosurg. 104(5 Suppl):302-4, 2006
                                              26. Sharma U et al: Potential of proton magnetic resonance spectroscopy in the evaluation of patients with tethered cord syndrome following surgery. J Neurosurg. 105(5 Suppl):396-402, 2006
                                              27. Haro H et al: Long-term outcomes of surgical treatment for tethered cord syndrome. J Spinal Disord Tech. 17(1):16-20, 2004
                                              28. Yamada S et al: Pathophysiology of tethered cord syndrome: correlation with symptomatology. Neurosurg Focus. 16(2):E6, 2004
                                              29. Selcuki M et al: Is a filum terminale with a normal appearance really normal? Childs Nerv Syst. 19(1):3-10, 2003
                                              30. Barkovich A: Pediatric Neuroimaging. 3rd ed. Philadelphia: Lippincott-Raven. 648-50, 2000
                                              31. Unsinn KM et al: US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics. 20(4):923-38, 2000
                                              32. Yamada S et al: Adult tethered cord syndrome. J Spinal Disord. 13(4):319-23, 2000
                                              33. Iskandar BJ et al: Congenital tethered spinal cord syndrome in adults. J Neurosurg. 88(6):958-61, 1998
                                              34. Selcuki M et al: Management of tight filum terminale syndrome with special emphasis on normal level conus medullaris (NLCM). Surg Neurol. 50(4):318-22; discussion 322, 1998
                                              35. Souweidane MM et al: Retethering of sectioned fibrolipomatous filum terminales: report of two cases. Neurosurgery. 42(6):1390-3, 1998
                                              36. Sharif S et al: "Tethered cord syndrome"--recent clinical experience. Br J Neurosurg. 11(1):49-51, 1997
                                              37. Yundt KD et al: Normal diameter of filum terminale in children: in vivo measurement. Pediatr Neurosurg. 27(5):257-9, 1997
                                              38. Beek FJ et al: Sonographic determination of the position of the conus medullaris in premature and term infants. Neuroradiology. 38 Suppl 1:S174-7, 1996
                                              39. Brunelle F et al: Lumbar spinal cord motion measurement with phase-contrast MR imaging in normal children and in children with spinal lipomas. Pediatr Radiol. 26(4):265-70, 1996
                                              40. Yamada S et al: Pathophysiology of tethered cord syndrome. Neurosurg Clin N Am. 6(2):311-23, 1995
                                              41. Warder DE et al: Tethered cord syndrome: the low-lying and normally positioned conus. Neurosurgery. 34(4):597-600; discussion 600, 1994
                                              42. Warder DE et al: Tethered cord syndrome and the conus in a normal position. Neurosurgery. 33(3):374-8, 1993
                                              43. Chestnut R et al: The Vater association and spinal dysraphia. Pediatr Neurosurg. 18(3):144-8, 1992
                                              44. Raghavan N et al: MR imaging in the tethered spinal cord syndrome. AJR Am J Roentgenol. 152(4):843-52, 1989
                                              45. Wilson DA et al: John Caffey award. MR imaging determination of the location of the normal conus medullaris throughout childhood. AJR Am J Roentgenol. 152(5):1029-32, 1989
                                              46. Kang JK et al: Effects of tethering on regional spinal cord blood flow and sensory-evoked potentials in growing cats. Childs Nerv Syst. 3(1):35-9, 1987
                                              47. Pang D et al: Tethered cord syndrome in adults. J Neurosurg. 57(1):32-47, 1982
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Tethered cord syndrome (TCS), tight filum terminale syndrome (TFTS)
                                                          • Definitions

                                                            • Symptoms and imaging findings related to low-lying conus medullaris tethered by short, thick filum terminale

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Ultrasonographic Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Kucera JN et al: The simple sacral dimple: diagnostic yield of ultrasound in neonates. Pediatr Radiol. ePub, 2014
                                                                                          2. Scottoni F et al: Spinal ultrasound in patients with anorectal malformations: is this the end of an era? Pediatr Surg Int. ePub, 2014
                                                                                          3. Al-Holou WN et al: The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome. J Neurosurg Pediatr. 4(1):28-36, 2009
                                                                                          4. Bauer DF et al: Study of the effects of flexion on the position of the conus medullaris: follow-up study using MR imaging in non-human primates. Childs Nerv Syst. 25(8):977-9, 2009
                                                                                          5. Ben-Sira L et al: Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr. 155(6):864-9, 2009
                                                                                          6. Hsu AR et al: Resolution of syringomyelia after release of tethered cord. Surg Neurol. Epub ahead of print, 2009
                                                                                          7. Husain AM et al: Prognostic value of neurophysiologic intraoperative monitoring in tethered cord syndrome surgery. J Clin Neurophysiol. 26(4):244-7, 2009
                                                                                          8. McGirt MJ et al: Pediatric tethered cord syndrome: response of scoliosis to untethering procedures. Clinical article. J Neurosurg Pediatr. 4(3):270-4, 2009
                                                                                          9. Aufschnaiter K et al: Surgery in adult onset tethered cord syndrome (ATCS): review of literature on occasion of an exceptional case. Neurosurg Rev. 31(4):371-83; discussion 384, 2008
                                                                                          10. Bauer DF et al: Study of the effects of flexion on the position of the conus medullaris. Childs Nerv Syst. 24(9):1043-5, 2008
                                                                                          11. Caird J et al: Significant clinical and radiological resolution of a spinal cord syrinx following the release of a tethered cord in a patient with an anatomically normal conus medullaris. Case report. J Neurosurg Pediatr. 1(5):396-8, 2008
                                                                                          12. Deeg KH et al: Spinal sonography in newborns and infants - part II: spinal dysraphism and tethered cord. Ultraschall Med. 29(1):77-88, 2008
                                                                                          13. Düz B et al: Tethered cord syndrome in adulthood. J Spinal Cord Med. 31(3):272-8, 2008
                                                                                          14. Skeik N et al: Intermittent back and leg pain with numbness. Tethered spinal cord syndrome. Am Fam Physician. 78(7):869-70, 2008
                                                                                          15. Agarwalla PK et al: Tethered cord syndrome. Neurosurg Clin N Am. 18(3):531-47, 2007
                                                                                          16. Bao N et al: Tight filum terminale syndrome in children: analysis based on positioning of the conus and absence or presence of lumbosacral lipoma. Childs Nerv Syst. 23(10):1129-34, 2007
                                                                                          17. Bui CJ et al: Tethered cord syndrome in children: a review. Neurosurg Focus. 23(2):1-9, 2007
                                                                                          18. Hajnovic L et al: Tethered spinal cord syndrome--the importance of time for outcomes. Eur J Pediatr Surg. 17(3):190-3, 2007
                                                                                          19. Lad SP et al: Tethered cord syndrome: nationwide inpatient complications and outcomes. Neurosurg Focus. 23(2):1-5, 2007
                                                                                          20. Lew SM et al: Tethered cord syndrome: an updated review. Pediatr Neurosurg. 43(3):236-48, 2007
                                                                                          21. Selden NR: Minimal tethered cord syndrome: what's necessary to justify a new surgical indication? Neurosurg Focus. 23(2):1-5, 2007
                                                                                          22. Yamada S et al: Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg Focus. 23(2):1-10, 2007
                                                                                          23. Yamada S et al: What is the true tethered cord syndrome? Childs Nerv Syst. 23(4):371-5, 2007
                                                                                          24. Drake JM: Occult tethered cord syndrome: not an indication for surgery. J Neurosurg. 104(5 Suppl):305-8, 2006
                                                                                          25. Selden NR: Occult tethered cord syndrome: the case for surgery. J Neurosurg. 104(5 Suppl):302-4, 2006
                                                                                          26. Sharma U et al: Potential of proton magnetic resonance spectroscopy in the evaluation of patients with tethered cord syndrome following surgery. J Neurosurg. 105(5 Suppl):396-402, 2006
                                                                                          27. Haro H et al: Long-term outcomes of surgical treatment for tethered cord syndrome. J Spinal Disord Tech. 17(1):16-20, 2004
                                                                                          28. Yamada S et al: Pathophysiology of tethered cord syndrome: correlation with symptomatology. Neurosurg Focus. 16(2):E6, 2004
                                                                                          29. Selcuki M et al: Is a filum terminale with a normal appearance really normal? Childs Nerv Syst. 19(1):3-10, 2003
                                                                                          30. Barkovich A: Pediatric Neuroimaging. 3rd ed. Philadelphia: Lippincott-Raven. 648-50, 2000
                                                                                          31. Unsinn KM et al: US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics. 20(4):923-38, 2000
                                                                                          32. Yamada S et al: Adult tethered cord syndrome. J Spinal Disord. 13(4):319-23, 2000
                                                                                          33. Iskandar BJ et al: Congenital tethered spinal cord syndrome in adults. J Neurosurg. 88(6):958-61, 1998
                                                                                          34. Selcuki M et al: Management of tight filum terminale syndrome with special emphasis on normal level conus medullaris (NLCM). Surg Neurol. 50(4):318-22; discussion 322, 1998
                                                                                          35. Souweidane MM et al: Retethering of sectioned fibrolipomatous filum terminales: report of two cases. Neurosurgery. 42(6):1390-3, 1998
                                                                                          36. Sharif S et al: "Tethered cord syndrome"--recent clinical experience. Br J Neurosurg. 11(1):49-51, 1997
                                                                                          37. Yundt KD et al: Normal diameter of filum terminale in children: in vivo measurement. Pediatr Neurosurg. 27(5):257-9, 1997
                                                                                          38. Beek FJ et al: Sonographic determination of the position of the conus medullaris in premature and term infants. Neuroradiology. 38 Suppl 1:S174-7, 1996
                                                                                          39. Brunelle F et al: Lumbar spinal cord motion measurement with phase-contrast MR imaging in normal children and in children with spinal lipomas. Pediatr Radiol. 26(4):265-70, 1996
                                                                                          40. Yamada S et al: Pathophysiology of tethered cord syndrome. Neurosurg Clin N Am. 6(2):311-23, 1995
                                                                                          41. Warder DE et al: Tethered cord syndrome: the low-lying and normally positioned conus. Neurosurgery. 34(4):597-600; discussion 600, 1994
                                                                                          42. Warder DE et al: Tethered cord syndrome and the conus in a normal position. Neurosurgery. 33(3):374-8, 1993
                                                                                          43. Chestnut R et al: The Vater association and spinal dysraphia. Pediatr Neurosurg. 18(3):144-8, 1992
                                                                                          44. Raghavan N et al: MR imaging in the tethered spinal cord syndrome. AJR Am J Roentgenol. 152(4):843-52, 1989
                                                                                          45. Wilson DA et al: John Caffey award. MR imaging determination of the location of the normal conus medullaris throughout childhood. AJR Am J Roentgenol. 152(5):1029-32, 1989
                                                                                          46. Kang JK et al: Effects of tethering on regional spinal cord blood flow and sensory-evoked potentials in growing cats. Childs Nerv Syst. 3(1):35-9, 1987
                                                                                          47. Pang D et al: Tethered cord syndrome in adults. J Neurosurg. 57(1):32-47, 1982