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Diagnosis of tethered cords by magnetic resonance imaging
W A Hall1, A L Albright, J A Brunberg
1Department of Neurosurgery, University Health Center of Pittsburgh, Pennsylvania.
Insights
Magnetic resonance imaging (MRI) is the top diagnostic tool for tethered spinal cord. Postoperative MRI shows spinal cord ascent is less common than expected, and retethering can occur.
Area of Science:
- Pediatric Neurosurgery
- Diagnostic Imaging
- Spinal Cord Disorders
Background:
- Tethered spinal cord is a serious condition requiring accurate diagnosis.
- Spina bifida occulta and myelomeningocele repair are common associations.
- Preoperative assessment is crucial for surgical planning.
Purpose of the Study:
- To evaluate the diagnostic accuracy of MRI for tethered spinal cord.
- To assess spinal cord ascent and retethering after surgical repair using MRI.
Main Methods:
- Retrospective review of 30 pediatric patients with tethered spinal cord symptoms.
- Preoperative and postoperative magnetic resonance imaging (MRI) analysis.
- Correlation of imaging findings with surgical outcomes.
Main Results:
- MRI accurately identified tethering, intradural fat, syrinxes, and thickened filum terminale.
- Excellent correlation between preoperative MRI and surgical findings.
- Postoperative MRI revealed limited spinal cord ascent and suspected retethering in several cases.
Conclusions:
- MRI is the preferred diagnostic modality for tethered spinal cord due to its accuracy and non-invasive nature.
- Spinal cord ascent post-surgery occurs less frequently than anticipated.
- Retethering is a potential complication, particularly with cadaveric dura mater grafts.
Abstract:
Thirty children presented with signs and/or symptoms of tethered spinal cord, 13 in association with spina bifida occulta and 17 after myelomeningocele repair. Preoperative magnetic resonance imaging (MRI) of 27 children showed tethering (27), intradural fat (17), distal syrinxes (8), and thickened filum terminale (2). There was an excellent correlation between MRI and the surgical findings. Postoperative MRI was obtained within 1 year after operation in 14 children; spinal cord ascent was seen on only four studies and retethering was suspected on five studies. We consider MRI the procedure of choice to diagnose a tethered cord because this technique accurately defines anatomical relationships without risk to the patient. In addition, we conclude that cord ascent is seen less often than expected and that retethering may occur, especially to cadaveric dura mater.