17 The Normal Position of the Conus Medullaris Does Not Exclude a Tethered Spinal Cord

2010 ◽  
Keyword(s):  
Spinal Cord ◽  
Conus Medullaris ◽  
Tethered Spinal Cord ◽  
Normal Position

Spine-shortening vertebral osteotomy in a patient with tethered cord syndrome and a vertebral fracture

2008 ◽  
Vol 9 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Haruo Kanno ◽  
Toshimi Aizawa ◽  
Hiroshi Ozawa ◽  
Takeshi Hoshikawa ◽  
Eiji Itoi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Fracture ◽  
Rare Case ◽  
Tethered Cord ◽  
Conus Medullaris ◽  
Tethered Cord Syndrome ◽  
Bone Union ◽  
Tethered Spinal Cord ◽  
Fracture Fragment ◽  
Loss Of Correction

The authors report a rare case of tethered cord syndrome with low-placed conus medullaris complicated by a vertebral fracture that was successfully treated by a spine-shortening vertebral osteotomy. The patient was a 57-year-old woman whose neurological condition worsened after a T-12 vertebral fracture because a fracture fragment and the associated local kyphotic deformity directly compressed the tethered spinal cord. An osteotomy of the T-12 vertebra was performed in order to correct the kyphosis, remove the fracture fragment, and reduce the tension on the spinal cord. Postoperative radiographs showed the spine to be shortened by 22 mm, and the kyphosis between T-11 and L-1 improved from 23° to 0°. Two years after the surgery, the patient's neurological symptoms were resolved. The bone union was complete with no loss of correction.

scholarly journals Tethered Cord Syndrome

2019 ◽  
Vol 3 (3) ◽  
pp. 297-298
Author(s):  
Shawn Catmull ◽  
John Ashurst
Keyword(s):  
Spinal Cord ◽  
Emergency Department ◽  
Emergency Physician ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Tethered Cord ◽  
Signs And Symptoms ◽  
Conus Medullaris ◽  
Tethered Spinal Cord ◽  
Sensory Dysfunction

Tethered spinal cord syndrome refers to signs and symptoms of motor and sensory dysfunction related to increased tension on the spinal cord due to its abnormal attachment; it has classically been associated with a low-lying conus medullaris. Treatment is primarily surgical and has varying degrees of results. Although rarely diagnosed in the emergency department, the emergency physician must be aware of the disease in patients presenting with signs and symptoms concerning for cauda equina syndrome.

scholarly journals Determination of Fetal Spinal Cord Measurement for Every Gestation Age

2020 ◽  
Vol 3 ◽  
Author(s):  
Hamna Qureshi ◽  
Megan Beth Marine ◽  
Nucharin Supakal ◽  
Monica Forbes-Amrhein
Keyword(s):  
Spinal Cord ◽  
Pilot Study ◽  
Spinal Canal ◽  
Conus Medullaris ◽  
The Body ◽  
Sensory Loss ◽  
Sacrococcygeal Teratoma ◽  
Tethered Spinal Cord ◽  
Gestation Age ◽  
Cord Length

Background and Hypothesis:  Tethered spinal cord is challenging to identify in fetuses. If untreated, tethered spinal cord can result in neurologic weakness and sensory loss in the lower half of the body. The goal of this study is to develop a library of normal ratios of the position of the conus medullaris relative to the spinal canal from normal fetal magnetic resonance imaging (MRI) examinations at each gestation age. This will allow for early identification of tethered spinal cord and timely intervention. We hypothesize that the ratios will decrease throughout pregnancy as the level of the conus medullaris rises.  Experimental Design or Project Methods:  In this pilot study, a retrospective review of fetal MRIs from patients between 20-38 weeks gestation age were examined. Exclusion criteria included fetuses with fetal spinal or central nervous system anomalies, VACTERL, ventral wall defects, scoliosis, and sacrococcygeal teratoma. The length from the fetal obex to the conus medullaris was measured and defined as the spinal cord length. The length of the obex to the caudal thecal sac was defined as the spinal canal length. The ratio of the spinal cord length to the spinal canal length was calculated. The ratios at each gestation age were compared using ANOVA (p < 0.05).  Results:  A total of 225 patients were reviewed. We observed a statistically significant decreasing trend in fetal spinal ratios from 20-38 weeks of gestation age. The average ratio at 20 weeks gestation age is 0.756 and at 38 weeks is 0.696.   Conclusion and Potential Impact:  This retrospective pilot study of fetal MRIs will establish reference values for the ratio of spinal cord to spinal canal lengths at progressing gestation ages. Ultimately, these ratios can establish normal values for identification of tethered spinal cord during the fetal period, thereby allowing early intervention to mitigate complications.  

Correlation between Magnetic Resonance Imaging and Surgical Findings in the Tethered Spinal Cord

Neurosurgery ◽  
1989 ◽  
Vol 25 (3) ◽  
pp. 341-346 ◽  
Author(s):  
Nazih A. Moufarrij ◽  
Joann M. Palmer ◽  
Joseph F. Hahn ◽  
Meredith A. Weinstein
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Scar Tissue ◽  
Conus Medullaris ◽  
Tethered Spinal Cord ◽  
Filum Terminale ◽  
Resonance Imaging ◽  
Mri Scans ◽  
Intradural Lipoma

Abstract Between October 1982 and August 1987, 20 patients underwent magnetic resonance imaging (MRI) and subsequent surgical release of a tethered spinal cord. The tethering was caused by a thick filum terminale in 6 patients. On MRI scans, the conus medullaris was at L4 in 2 patients, at L2 in 3 patients, and the filum terminale appeared thick in 1 patient. The spinal cord was tethered to an intradural lipoma correctly demonstrated by MRI in 6 patients. Increased epidural fat was misdiagnosed as an intradural lipoma in one patient and a lipomatous stalk was not identified in 2 other patients. Scar tissue resulting from repair of a meningocele had tethered the cord in the remaining 8 patients. On MRI scans, the conus medullaris was located between L3 and S3; in 5 of the patients, scar tissue was apparent on the MRI scan. This correlative study supports the use of MRI as the initial, and possibly the only, imaging modality when a tethered spinal cord is suspected. Improved or more recent MRI techniques will help demonstrate these anomalies better.

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

MR imaging of ventriculus terminalis of the conus medullaris: A report of two operated patients and review of the literature

2003 ◽  
Vol 44 (4) ◽  
pp. 444-446
Author(s):  
R. Dullerud ◽  
A. Server ◽  
J. Berg-Johnsen
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Signal Intensity ◽  
Incidental Finding ◽  
Conus Medullaris ◽  
Review Of The Literature ◽  
Per Se ◽  
Specific Symptoms ◽  
Work Up

We report on 2 patients in whom a cystic dilation of the conus medullaris was incidentally found at MR imaging carried out in the work-up for sciatica. The cysts were well circumscribed and had signal intensity identical to the CSF on both T1- and T2-weighted images. There was no evidence of contrast enhancement. None of the patients had specific symptoms related to the spinal cord. At surgery, no evidence of malignancy was seen in any of the patients. A benign cystic dilation, also called dilated ventriculus terminalis, occasionally can be seen in the conus medullaris as an incidental finding at thoracolumbar MR imaging. Unless the expansion per se indicates cyst drainage, these patients may be monitored by clinical and MR follow-up, avoiding surgery in a substantial number of cases.

Spinal cord arteriovenous fistulas involving the conus medullaris: presentation, management, and embryologic considerations

1999 ◽  
Vol 52 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Robert W Hurst ◽  
Linda J Bagley ◽  
Paul Marcotte ◽  
Luis Schut ◽  
Eugene S Flamm
Keyword(s):  
Spinal Cord ◽  
Conus Medullaris ◽  
Arteriovenous Fistulas
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