Paediatric ImagingTethered cord syndrome
clinical presentation of painful or poor sensation of the lower limbs, spastic gait, muscle atrophy, and sometimes neurogenic manifestations in bladder and bowel. A claw foot deformity may be associated with tethering of the cord to a placode within the spinal canal. It is a known association of myelomeningocele. It may also be associated with other forms of spinal dysraphism,
intraspinal dermoid and subcutaneous lipomas.
If there are associated spinal anomalies these will be evident on the radiographic examination but, once suspected, MR imaging is indicated to fully assess the anatomy. In the young infant, ultrasound is an ideal method of identifying the position of the lower end of the cord. When there is tethering, the cord is seen to extend below the border of L1. On occasion, one can also see associated hydromyelia or other spinal cord malformations as well (Fig.1). On MRI, a low thickened filum terminale is present with a low position of the cord conus (Fig.2). Other findings reflect the underlying condition, e.g. an intrathecal dermoid, lipoma or haemangioma, or a myelomeningocele.
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Sonogram in the longitudinal plane of the spine at the level of L4 showing appearance of the spinal cord extending to this level. The normal cord is composed of two echogenic outer parallel lines enclosing the more echopoor centre.
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Tethered cord syndrome, Fig.1 | | Tethered cord syndrome, Fig.2 | |