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Can the conus medullaris in normal position be tethered?
1Department of Cell Biology, University of Alabama at Birmingham, Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA. richard.tubbs@ccc.uab.edu
Neurological Research
|October 21, 2004
Summary
Tethered spinal cord syndrome may present clinically despite normal imaging findings. Diagnosis requires integrating imaging with clinical symptoms and physical examination, not solely relying on conus medullaris position.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- The traditional definition of tethered spinal cord syndrome often links it to a pathologically elongated conus medullaris.
- Radiological criteria typically consider a conus medullaris below the L-2 vertebra as indicative of pathology.
Purpose of the Study:
- To investigate the clinical presentation of tethered spinal cord syndrome in patients with radiologically normal conus medullaris position.
- To emphasize the importance of clinical evaluation alongside imaging in diagnosing tethered cord syndrome.
Main Methods:
- Review of prior literature and clinical case series.
- Correlation of radiological findings (conus medullaris position) with clinical symptoms and physical examination findings.
Main Results:
- A subset of patients exhibit clinical symptoms of tethered spinal cord syndrome despite the conus medullaris terminating at a conventionally accepted normal vertebral level.
- Literature review indicates prior surgical interventions in cases with 'normal' conus termination.
Conclusions:
- Tethered spinal cord syndrome can occur even when the conus medullaris is within normal anatomical limits.
- Diagnosis and treatment decisions for tethered cord syndrome should integrate imaging with comprehensive clinical assessment, recognizing a normal range for conus termination, and considering cord 'tautness' over simple elongation.