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Bucket Handle Fracture
Joseph Junewick, MD FACR
over 5 years ago
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Tethered Cord

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 3 years ago
Updated: over 3 years ago
Tags: PEDS
Modality/Study Types: US
Activities:
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History

Newborn female with bladder extrophy and anal atresia.


Case Images


Diagnosis

Tethered Cord

Findings

US – Sagittal and high resolution sagittal images of the spine show an elongated conus medullaris terminating at S2 with thickened filum terminale.

Discussion

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).

Reference

Lowe LH, Johanek AJ, Moore CW. Sonography of the Neonatal Spine: Part 2, Spinal Disorders. AJR (2007); 188:739-744.



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