Heather Borders, MD
over 5 years ago
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Joseph Junewick, MD FACR
|Diagnostic Category: Developmental or Congenital
|Created: over 4 years ago
|Updated: over 4 years ago
Newborn female with bladder extrophy and anal atresia.
US – Sagittal and high resolution sagittal images of the spine show an elongated conus medullaris terminating at S2 with thickened filum terminale.
The caudal end of the spinal cord represents the conus medullaris which continues as the filum terminale. Normally, the tip of the conus medullaris is located between L1 and L2. Differentiation of the filum terminale from the nerve roots is sometimes difficult. Tethered cord is caused by incomplete regressive differentiation and failed involution of the terminal cord. Symptoms occur because of traction on the abnormally anchored filum terminale and adjacent nerve roots. Patients with tethered cord may present at any age. Tethered cord is diagnosed when the conus extends below the L2-L3 disk space. Lack of normal nerve root motion, thickened filum terminale, spinal dysraphism, syringomyelia, scoliosis, intraspinal masses and dermal sinus tracts support the diagnosis. Release of the tether helps minimize injury to the cord and cauda equina. Anomalies associated with tethered cord include tracheoesophageal fistula, congenital heart disease, and renal anomalies (VATER syndrome).
Lowe LH, Johanek AJ, Moore CW. Sonography of the Neonatal Spine: Part 2, Spinal Disorders. AJR (2007); 188:739-744.