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Tethered Spinal Cord
Blaise V. Jones, MD
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KEY FACTS

  • Imaging

    • Pathology

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Tethered cord syndrome, tight filum terminale syndrome
          • Definitions

            • Abnormally low position & restricted mobility of conus medullaris, in concert with characteristic symptoms

          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. Ladino Torres MF et al: Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR. 35(6):652-61, 2014
                                          2. Singh S et al: Comparison of standard, prone and cine MRI in the evaluation of tethered cord. Pediatr Radiol. 42(6):685-91, 2012
                                          3. O'Neill BR et al: Prevalence of tethered spinal cord in infants with VACTERL. J Neurosurg Pediatr. 6(2):177-82, 2010
                                          4. 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
                                          5. 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
                                          6. Ben-Sira L et al: Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr. 155(6):864-9, 2009
                                          7. Hsu AR et al: Resolution of syringomyelia after release of tethered cord. Surg Neurol. 72(6):657-61, 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
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Imaging

                                            • Pathology

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Tethered cord syndrome, tight filum terminale syndrome
                                                  • Definitions

                                                    • Abnormally low position & restricted mobility of conus medullaris, in concert with characteristic symptoms

                                                  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. Ladino Torres MF et al: Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR. 35(6):652-61, 2014
                                                                                  2. Singh S et al: Comparison of standard, prone and cine MRI in the evaluation of tethered cord. Pediatr Radiol. 42(6):685-91, 2012
                                                                                  3. O'Neill BR et al: Prevalence of tethered spinal cord in infants with VACTERL. J Neurosurg Pediatr. 6(2):177-82, 2010
                                                                                  4. 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
                                                                                  5. 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
                                                                                  6. Ben-Sira L et al: Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr. 155(6):864-9, 2009
                                                                                  7. Hsu AR et al: Resolution of syringomyelia after release of tethered cord. Surg Neurol. 72(6):657-61, 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