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Tethered thoracic cord resulting from spinal cord herniation
1Department of Rehabilitation, New York Hospital-Cornell Medical Center, USA.
Archives of Physical Medicine and Rehabilitation
|May 1, 1997
Summary
Tethered cord syndrome (TCS) can occur in the thoracic spine due to spinal cord herniation, not just the lower cord. Early recognition of this rare condition is crucial to prevent progressive neurological disability.
Area of Science:
- Neurology
- Neurosurgery
- Spinal Cord Imaging
Background:
- Tethered cord syndrome (TCS) typically affects the conus medullaris.
- Thoracic spinal cord tethering is an uncommon presentation.
- Spinal cord herniation can lead to TCS.
Observation:
- A 30-year-old woman experienced progressive myelopathy attributed to a T6-T8 arachnoid cyst.
- Despite partial cyst excision, her condition worsened, with imaging suggesting recurrence and T6-T8 cord tethering.
- Surgical exploration revealed a myelocele with anterior thoracic dural herniation.
Findings:
- Pathological examination confirmed neural tissue with gliosis.
- Post-surgical physical therapy improved lower extremity strength and bladder control.
- The patient achieved ambulation with a cane.
Implications:
- Progressive myelopathy can indicate tethered cord syndrome resulting from spinal cord herniation.
- Prompt diagnosis of TCS, even with subtle deficits, is vital for preventing irreversible disability.
- This case highlights the importance of considering spinal cord herniation in thoracic TCS etiology.