The wedge-shaped cord terminus: a radiographic sign of caudal regression

Imaging studies from 13 patients with caudal regression were reviewed retrospectively to assess the spectrum and findings of this anomaly. Seven patients were evaluated with MR and six with myelography (supplemented with CT in three). The level of regression varied from T9 to the coccyx. Although osseous abnormalities were more readily identified and characterized by CT, MR effectively depicted the level of vertebral regression, presence of central spinal stenosis, and vertebral dysraphic anomalies. MR demonstrated a characteristic wedge-shaped (longer dorsally) cord terminus in seven of the patients. When this characteristic cord terminus is seen, imaging of the lower lumbar and sacral regions should be performed to verify the diagnosis of caudal regression. Tethered spinal cords have been described in patients with caudal regression and were seen in two of our patients. We present the first cases of individuals who have survived with absence of vertebrae above the T10 level and an unusual case of caudal regression with absent lumbar vertebrae and preserved lower sacral and coccygeal vertebrae. The syndrome of caudal regression encompasses a wide spectrum of pathology that is analyzed well by modern imaging techniques.