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Pediatrics
Diagnosis
Pediatric Neuroradiology
Spine
Congenital and Genetic Disorders
Congenital
Anomalies of Caudal Cell Mess
Tethered Spinal Cord
Tethered Spinal Cord
Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • 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. Choi JH et al: Outcome of ultrasonographic imaging in infants with sacral dimple. Korean J Pediatr. 61(6):194-99, 2018
                                            2. Gupta A et al: Fatty filum terminale (FFT) as a secondary tethering element in children with closed spinal dysraphism. Childs Nerv Syst. 34(5):925-32, 2018
                                            3. Heemskerk JL et al: Prevalence and risk factors for neural axis anomalies in idiopathic scoliosis: a systematic review. Spine J. 18(7):1261-71, 2018
                                            4. Lin W et al: Spine-shortening osteotomy for patients with tethered cord syndrome: a systematic review and meta-analysis. Neurol Res. 40(5):340-63, 2018
                                            5. Seki T et al: Surgical outcomes of pediatric patients with asymptomatic tethered cord syndrome. Asian Spine J. 12(3):551-55, 2018
                                            6. Shukla M et al: Adult versus pediatric tethered cord syndrome: clinicoradiological differences and its management. Asian J Neurosurg. 13(2):264-70, 2018
                                            7. Stamates MM et al: Magnetic resonance imaging in the prone position and the diagnosis of tethered spinal cord. J Neurosurg Pediatr. 21(1):4-10, 2018
                                            8. Sysoev K et al: Prognosis of surgical treatment of the tethered cord syndrome in children. Childs Nerv Syst. 34(2):305-10, 2018
                                            9. Tuite GF et al: Evaluation and management of tethered cord syndrome in occult spinal dysraphism: recommendations from the international children's continence society. Neurourol Urodyn. 37(3):890-903, 2018
                                            10. Ladino Torres MF et al: Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR. 35(6):652-61, 2014
                                            11. Singh S et al: Comparison of standard, prone and cine MRI in the evaluation of tethered cord. Pediatr Radiol. 42(6):685-91, 2012
                                            12. O'Neill BR et al: Prevalence of tethered spinal cord in infants with VACTERL. J Neurosurg Pediatr. 6(2):177-82, 2010
                                            13. 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
                                            14. 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
                                            15. Ben-Sira L et al: Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr. 155(6):864-9, 2009
                                            16. Hsu AR et al: Resolution of syringomyelia after release of tethered cord. Surg Neurol. 72(6):657-61, 2009
                                            17. McGirt MJ et al: Pediatric tethered cord syndrome: response of scoliosis to untethering procedures. Clinical article. J Neurosurg Pediatr. 4(3):270-4, 2009
                                            18. 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
                                            19. 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
                                            20. 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
                                            21. Deeg KH et al: Spinal sonography in newborns and infants - part II: spinal dysraphism and tethered cord. Ultraschall Med. 29(1):77-88, 2008
                                            22. Düz B et al: Tethered cord syndrome in adulthood. J Spinal Cord Med. 31(3):272-8, 2008
                                            23. Skeik N et al: Intermittent back and leg pain with numbness. Tethered spinal cord syndrome. Am Fam Physician. 78(7):869-70, 2008
                                            24. Agarwalla PK et al: Tethered cord syndrome. Neurosurg Clin N Am. 18(3):531-47, 2007
                                            25. 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
                                            26. 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

                                            • Terminology

                                              • 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. Choi JH et al: Outcome of ultrasonographic imaging in infants with sacral dimple. Korean J Pediatr. 61(6):194-99, 2018
                                                                                      2. Gupta A et al: Fatty filum terminale (FFT) as a secondary tethering element in children with closed spinal dysraphism. Childs Nerv Syst. 34(5):925-32, 2018
                                                                                      3. Heemskerk JL et al: Prevalence and risk factors for neural axis anomalies in idiopathic scoliosis: a systematic review. Spine J. 18(7):1261-71, 2018
                                                                                      4. Lin W et al: Spine-shortening osteotomy for patients with tethered cord syndrome: a systematic review and meta-analysis. Neurol Res. 40(5):340-63, 2018
                                                                                      5. Seki T et al: Surgical outcomes of pediatric patients with asymptomatic tethered cord syndrome. Asian Spine J. 12(3):551-55, 2018
                                                                                      6. Shukla M et al: Adult versus pediatric tethered cord syndrome: clinicoradiological differences and its management. Asian J Neurosurg. 13(2):264-70, 2018
                                                                                      7. Stamates MM et al: Magnetic resonance imaging in the prone position and the diagnosis of tethered spinal cord. J Neurosurg Pediatr. 21(1):4-10, 2018
                                                                                      8. Sysoev K et al: Prognosis of surgical treatment of the tethered cord syndrome in children. Childs Nerv Syst. 34(2):305-10, 2018
                                                                                      9. Tuite GF et al: Evaluation and management of tethered cord syndrome in occult spinal dysraphism: recommendations from the international children's continence society. Neurourol Urodyn. 37(3):890-903, 2018
                                                                                      10. Ladino Torres MF et al: Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR. 35(6):652-61, 2014
                                                                                      11. Singh S et al: Comparison of standard, prone and cine MRI in the evaluation of tethered cord. Pediatr Radiol. 42(6):685-91, 2012
                                                                                      12. O'Neill BR et al: Prevalence of tethered spinal cord in infants with VACTERL. J Neurosurg Pediatr. 6(2):177-82, 2010
                                                                                      13. 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
                                                                                      14. 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
                                                                                      15. Ben-Sira L et al: Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr. 155(6):864-9, 2009
                                                                                      16. Hsu AR et al: Resolution of syringomyelia after release of tethered cord. Surg Neurol. 72(6):657-61, 2009
                                                                                      17. McGirt MJ et al: Pediatric tethered cord syndrome: response of scoliosis to untethering procedures. Clinical article. J Neurosurg Pediatr. 4(3):270-4, 2009
                                                                                      18. 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
                                                                                      19. 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
                                                                                      20. 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
                                                                                      21. Deeg KH et al: Spinal sonography in newborns and infants - part II: spinal dysraphism and tethered cord. Ultraschall Med. 29(1):77-88, 2008
                                                                                      22. Düz B et al: Tethered cord syndrome in adulthood. J Spinal Cord Med. 31(3):272-8, 2008
                                                                                      23. Skeik N et al: Intermittent back and leg pain with numbness. Tethered spinal cord syndrome. Am Fam Physician. 78(7):869-70, 2008
                                                                                      24. Agarwalla PK et al: Tethered cord syndrome. Neurosurg Clin N Am. 18(3):531-47, 2007
                                                                                      25. 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
                                                                                      26. Bui CJ et al: Tethered cord syndrome in children: a review. Neurosurg Focus. 23(2):1-9, 2007