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Tethered Spinal Cord
Blaise V. Jones, MD
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KEY FACTS

  • Imaging

    • Pathology

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Tethered cord syndrome, tight filum terminale syndrome
        • Definitions

          • Abnormally low position & restricted mobility of conus medullaris, in concert with characteristic symptoms
          • Tethered cord syndrome implies that there are associated symptoms
            • Spinal cord may appear tethered on imaging without overt 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. Apaydin M: Tethered cord syndrome and transitional vertebrae. Surg Radiol Anat. 42(2):111-9, 2020
                                        2. Wang H et al: Assessing spinal cord injury area in patients with tethered cord syndrome by diffusion tensor imaging. World Neurosurg. 127:e542-7, 2019
                                        3. 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
                                        4. Aldave G et al: Spinal column shortening for tethered cord syndrome associated with myelomeningocele, lumbosacral lipoma, and lipomyelomeningocele in children and young adults. J Neurosurg Pediatr. 19(6):703-10, 2017
                                        5. Ladino Torres MF et al: Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR. 35(6):652-61, 2014
                                        6. Singh S et al: Comparison of standard, prone and cine MRI in the evaluation of tethered cord. Pediatr Radiol. 42(6):685-91, 2012
                                        7. O'Neill BR et al: Prevalence of tethered spinal cord in infants with VACTERL. J Neurosurg Pediatr. 6(2):177-82, 2010
                                        8. 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
                                        9. 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
                                        10. Ben-Sira L et al: Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr. 155(6):864-9, 2009
                                        11. Hsu AR et al: Resolution of syringomyelia after release of tethered cord. Surg Neurol. 72(6):657-61, 2009
                                        12. McGirt MJ et al: Pediatric tethered cord syndrome: response of scoliosis to untethering procedures. Clinical article. J Neurosurg Pediatr. 4(3):270-4, 2009
                                        13. 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
                                        14. 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
                                        15. 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
                                        16. Deeg KH et al: Spinal sonography in newborns and infants - part II: spinal dysraphism and tethered cord. Ultraschall Med. 29(1):77-88, 2008
                                        17. Düz B et al: Tethered cord syndrome in adulthood. J Spinal Cord Med. 31(3):272-8, 2008
                                        18. Skeik N et al: Intermittent back and leg pain with numbness. Tethered spinal cord syndrome. Am Fam Physician. 78(7):869-70, 2008
                                        19. Agarwalla PK et al: Tethered cord syndrome. Neurosurg Clin N Am. 18(3):531-47, 2007
                                        20. 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
                                        21. 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

                                              TERMINOLOGY

                                              • Synonyms

                                                • Tethered cord syndrome, tight filum terminale syndrome
                                              • Definitions

                                                • Abnormally low position & restricted mobility of conus medullaris, in concert with characteristic symptoms
                                                • Tethered cord syndrome implies that there are associated symptoms
                                                  • Spinal cord may appear tethered on imaging without overt 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. Apaydin M: Tethered cord syndrome and transitional vertebrae. Surg Radiol Anat. 42(2):111-9, 2020
                                                                              2. Wang H et al: Assessing spinal cord injury area in patients with tethered cord syndrome by diffusion tensor imaging. World Neurosurg. 127:e542-7, 2019
                                                                              3. 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
                                                                              4. Aldave G et al: Spinal column shortening for tethered cord syndrome associated with myelomeningocele, lumbosacral lipoma, and lipomyelomeningocele in children and young adults. J Neurosurg Pediatr. 19(6):703-10, 2017
                                                                              5. Ladino Torres MF et al: Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR. 35(6):652-61, 2014
                                                                              6. Singh S et al: Comparison of standard, prone and cine MRI in the evaluation of tethered cord. Pediatr Radiol. 42(6):685-91, 2012
                                                                              7. O'Neill BR et al: Prevalence of tethered spinal cord in infants with VACTERL. J Neurosurg Pediatr. 6(2):177-82, 2010
                                                                              8. 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
                                                                              9. 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
                                                                              10. Ben-Sira L et al: Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr. 155(6):864-9, 2009
                                                                              11. Hsu AR et al: Resolution of syringomyelia after release of tethered cord. Surg Neurol. 72(6):657-61, 2009
                                                                              12. McGirt MJ et al: Pediatric tethered cord syndrome: response of scoliosis to untethering procedures. Clinical article. J Neurosurg Pediatr. 4(3):270-4, 2009
                                                                              13. 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
                                                                              14. 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
                                                                              15. 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
                                                                              16. Deeg KH et al: Spinal sonography in newborns and infants - part II: spinal dysraphism and tethered cord. Ultraschall Med. 29(1):77-88, 2008
                                                                              17. Düz B et al: Tethered cord syndrome in adulthood. J Spinal Cord Med. 31(3):272-8, 2008
                                                                              18. Skeik N et al: Intermittent back and leg pain with numbness. Tethered spinal cord syndrome. Am Fam Physician. 78(7):869-70, 2008
                                                                              19. Agarwalla PK et al: Tethered cord syndrome. Neurosurg Clin N Am. 18(3):531-47, 2007
                                                                              20. 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
                                                                              21. Bui CJ et al: Tethered cord syndrome in children: a review. Neurosurg Focus. 23(2):1-9, 2007