Spinal Cord Tethering

2019 ◽  
pp. 31-39
Author(s):  
Nathan R. Selden
Keyword(s):  
Spinal Cord ◽  
Voiding Dysfunction ◽  
Leg Pain ◽  
Lumbosacral Spine ◽  
Dermal Sinus ◽  
Filum Terminale ◽  
Diagnostic Modality ◽  
Magnetic Resonance Imaging Mri ◽  
Operative Assessment ◽  
Spinal Cord Tethering

Spinal cord tethering due to a tense filum terminale may present with clinical features that include voiding dysfunction, back and leg pain, musculoskeletal and/or sensorimotor abnormalities of the distal legs and feet, and gait dysfunction. External dysraphic markers may be present over the midline lumbosacral spine, including skin dimples, hemangiomata, atretic tails or skin tags, superficial dermal sinus tracts, and/or bifid or Y-shaped gluteal folds. Magnetic resonance imaging (MRI) remains the most clinically useful and definitive diagnostic modality for tethered spinal cord and should be used to assess the filum terminale, position of the conus tip, and presence of syringomyelia. Spinal cord tethering may be successfully treated with transection of the filum terminale. Careful peri-operative assessment and follow-up of voiding dysfunction and syringomyelia will optimize long-term outcomes.

scholarly journals An unusual case of unilateral limb hypertrophy: Lipoma of sacral roots

2012 ◽  
Vol 03 (01) ◽  
pp. 89-92 ◽  
Author(s):  
Archana B Netto ◽  
Sanjib Sinha ◽  
Arun B Taly ◽  
Chandrajit Prasad ◽  
A Mahadevan ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Unusual Case ◽  
Tethered Cord ◽  
Leg Pain ◽  
Lumbosacral Spine ◽  
Resonance Imaging ◽  
Chronic Denervation ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Progressive Enlargement

ABSTRACTWe report an unusual case of unilateral limb pseudo hypertrophy in a 21-year-old lady who developed progressive enlargement of the right calf followed by thigh in association with chronic leg pain. Magnetic resonance imaging (MRI) of the affected limb confirmed enlargement of various muscles. Electromyography revealed neurogenic features consistent with S1 radiculopathy. MRI of the lumbosacral spine showed tethered cord with a lipoma infiltrating multiple sacral roots. Our case illustrates that muscular pseudo hypertrophy may follow chronic denervation as a consequence of spinal neural compressive disease. The various mechanisms postulated for this distinct condition are outlined.

Retethering of transected fatty filum terminales

2011 ◽  
Vol 7 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Hideki Ogiwara ◽  
Arleta Lyszczarz ◽  
Tord D. Alden ◽  
Robin M. Bowman ◽  
David G. McLone ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Simple Procedure ◽  
Demographic Data ◽  
Rare Condition ◽  
Bladder Capacity ◽  
Leg Pain ◽  
Filum Terminale ◽  
The Mean

Object Untethering of a tethered spinal cord (TSC) by transecting or removing a fatty filum terminale is a relatively simple procedure that can prevent or ameliorate neurological symptoms, and the postoperative prognosis is usually good. Progressive neurological deterioration caused by recurrent tethering has been rarely reported. The authors present their experience in cases in which a sectioned fatty filum terminale has become retethered. Methods The authors retrospectively analyzed the surgical results of pediatric patients with fatty filum terminale–TSC treated by transection of the filum. The patients' charts were reviewed for demographic data, clinical presentation, surgical therapy, and follow-up data. Results Of the 225 children who underwent TSC release by sectioning the fatty filum from 1992 to 2005, there were 6 patients (2.7%; 3 males, 3 females) in whom the fatty filum retethered. The mean age at the first diagnosis of TSC was 5.2 years (range 2 months–12.3 years). The mean duration from the first untethering procedure to retethering was 5.4 years. The mean age at the time of retethering was 10.6 years (range 7–17.5 years). Symptoms of retethering were urinary incontinence, low-back pain, difficulty walking, constipation, leg pain, and worsening foot deformity. Patients underwent cystometrography at the time retethering was indicated by increased bladder capacity, large post-void residual volume, decreased bladder capacity, increase in filling pressure, and poor sensation of filling. Magnetic resonance imaging revealed adherence of the rostral stump of the sectioned filum to the midline dorsal dural surface. All patients underwent the second untethering procedure. Four patients improved neurologically and experienced no retethering thereafter (mean follow-up period 5.5 years). Two patients experienced additional retethering after temporary improvement following the second untethering procedure. Conclusions Retethering of the spinal cord is a rare condition occurring after the sectioning of a fatty filum terminale. Awareness of this rare sequela is necessary for appropriate long-term management of TSC caused by a fatty filum terminale. Cystometrography is useful for detecting the lesion and confirming the diagnosis of retethering.

scholarly journals Symptomatic spinal cord metastasis of glioblastoma multiforme

2018 ◽  
Vol 23 (3) ◽  
pp. 234-237
Author(s):  
Emerson Magno F. De Andrade ◽  
Sérgio De Freitas ◽  
Antônio Carlos Montanaro
Keyword(s):  
Spinal Cord ◽  
Glioblastoma Multiforme ◽  
Histopathological Examination ◽  
Spinal Metastasis ◽  
Previous History ◽  
Leg Pain ◽  
Resonance Imaging ◽  
History Of ◽  
Spinal Cord Metastasis ◽  
Magnetic Resonance Imaging Mri

Symptomatic spinal cord metastasis from glioblastoma multiforme (GBM) has rarely been reported in the literature. We report the case of a 27-year-old man that presented with back and bilateral leg pain nine months after the primarydiagnosis of intracranial GBM. A magnetic resonance imaging (MRI) of the lumbar spine showed a L1-L2 tumor that was removed successfully and histopathological examination was consistent with GBM metastasis. Spinal metastasis should be investigated and included in the differential diagnosis if a patient with a previous history of intracranial GBM presentswith spinal symptoms. 

scholarly journals Symptomatic spinal cord metastasis of glioblastoma multiforme

2018 ◽  
Vol 22 (2) ◽  
pp. 44-47
Author(s):  
Emerson Magno F. De Andrade ◽  
Sérgio De Freitas ◽  
Antônio Carlos Montanaro
Keyword(s):  
Spinal Cord ◽  
Glioblastoma Multiforme ◽  
Histopathological Examination ◽  
Spinal Metastasis ◽  
Previous History ◽  
Primary Diagnosis ◽  
Leg Pain ◽  
History Of ◽  
Spinal Cord Metastasis ◽  
Magnetic Resonance Imaging Mri

Symptomatic spinal cord metastasis from glioblastoma multiforme (GBM) has rarely been reported in the literature. We report the case of a 27-year-old man who presented with back and bilateral leg pain nine months after the primary diagnosis of intracranial GBM. A magnetic resonance imaging (MRI) of the lumbar spine showed a L1-L2 tumor that was removed successfully and histopathological examination was consistent with GBM metastasis. Spinal metastasis should be investigated and included in the differential diagnosis in a patient with a previous history of intracranial GBM presenting with spinal symptoms.

scholarly journals Intradural view of the spinal cord and dura after three-column osteotomy: illustrative case

2021 ◽  
Vol 2 (19) ◽  
Author(s):  
Zirun Zhao ◽  
Saman Shabani ◽  
Nitin Agarwal ◽  
Praveen V. Mummaneni ◽  
Dean Chou
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Urinary Incontinence ◽  
Spinal Column ◽  
Tethered Cord ◽  
Leg Pain ◽  
Illustrative Case ◽  
Resonance Imaging ◽  
Intraoperative Visualization ◽  
Spinal Cord Tethering

BACKGROUND A three-column osteotomy results in dural buckling, which may appear concerning upon intraoperative visualization because it may appear that the neural elements may also be buckled. The authors presented an intraoperative view after intentional durotomy of the neural elements and the relaxed state of the dura after three-column osteotomy. OBSERVATIONS A 52-year-old woman with adult tethered cord syndrome and previous untethering presented with worsening leg pain and stiffness, urinary incontinence, and unbalanced gait. Magnetic resonance imaging demonstrated an arachnoid web at T6 and spinal cord tethering. Spinal column shortening via three-column osteotomy was performed with concomitant intradural excision of the arachnoid web. Dural buckling was observed intraoperatively after spinal column shortening. After the durotomy, the spinal cord was visualized without kinking or buckling. LESSONS Dural buckling after spinal column shortening of 15 mm via three-column osteotomy at T6 did not result in concomitant buckling of the underlying neural elements.

scholarly journals Diagnostic performance of high-resolution ultrasound in pre- and postoperative evaluation of the hand tendons injuries

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ahmed Abdelrahman Mohamed Baz ◽  
Aya Bahaa Hussien ◽  
Hesham Mostafa Abdel Samad ◽  
Hatem Mohamed Said El-Azizi
Keyword(s):  
High Resolution ◽  
Preoperative Evaluation ◽  
Tendon Injuries ◽  
Diagnostic Modality ◽  
Complete Tear ◽  
Observational Cohort ◽  
Male Patients ◽  
Mri Study ◽  
Operative Assessment ◽  
Gold Standards

Abstract Background Hand tendon injuries are recognized clinical entities that are frequently seen. Clinical examinations usually warrant radiological correlative studies for confirmation and as a postoperative screening test. Here is a prospective observational cohort study enrolling 30 patients who were diagnosed clinically to have hand tendon injuries either pre- or postoperative; their ages were ranging from 5 to 64 years with a mean ± SD of 31.43 ± 12.19 years; 23 male patients (76.7%) and 7 female patients (23.3%) were evaluated by high-resolution ultrasound examination and a correlative evaluation was done by either intra-operative assessment or MRI study as gold standards. Results High-resolution ultrasound (HRUS) findings were binned into seventeen cases (56%) that had tendon tears, of which 10 cases (33.3%) had a complete tear and 7 cases (23.3%) had a partial tear. Postoperative tendon integrity was present in 13 cases (43.3%), a tendon callus was found in 2 cases (6.66%), and a postoperative abnormal motion on the dynamic study was present in 15 cases (50%). Intra-tendinous foreign bodies were detected in two cases (6.66%), a gap between the torn ends was found in 10 cases (33.3%), and re-tear (rupture) of the repaired tendons was present in four cases (13.3%). Coexistent nerve injuries were seen in two cases (6.66%); for the forementioned findings, HRUS had gained high accuracy measures as correlated to the gold standards (100% sensitivity and 100% specificity). Conclusion High-resolution ultrasound serves as a highly accurate potential diagnostic modality for preoperative evaluation of hand tendon injuries and the postoperative follow-up.

Magnetic Resonance Imaging of Spinal Cord Disease of Childhood

PEDIATRICS ◽  
1986 ◽  
Vol 78 (2) ◽  
pp. 251-256
Author(s):  
Roger J. Packer ◽  
Robert A. Zimmerman ◽  
Leslie N. Sutton ◽  
Larissa T. Bilaniuk ◽  
Derek A. Bruce ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Vertebral Body ◽  
Congenital Anomalies ◽  
Correct Diagnosis ◽  
Surface Coil ◽  
Resonance Imaging ◽  
Spinal Cord Disease ◽  
Magnetic Resonance Imaging Mri

Correct diagnosis of spinal cord disease in childhood is often delayed, resulting in irreversible neurologic deficits. A major reason for this delay is the lack of a reliable means to noninvasively visualize the spinal cord. Magnetic resonance imaging (MRI) should be useful in the evaluation of diseases of the spinal cord. A 1.5 Tesla MRI unit with a surface coil was used to study 41 children, including eight patients with intrinsic spinal cord lesions, eight patients with masses compressing the cord, 12 patients with congenital anomalies of the cord or surrounding bony structures, three patients with syrinxes, and three patients with vertebral body abnormalities. Intrinsic lesions of the cord were well seen in all cases as intrinsic irregularly widened, abnormally intense cord regions. MRI was helpful in following the course of disease in patients with primary spinal cord tumors. Areas of tumor were separable from syrinx cavities. Extrinsic lesions compressing the cord and vertebral body disease were also well visualized. Congenital anomalies of the spinal cord, including tethering and lipomatous tissue, were better seen on MRI than by any other radiographic technique. MRI is an excellent noninvasive "screening" technique for children with suspected spinal cord disease and may be the only study needed in many patients with congenital spinal cord anomalies. It is also an excellent means to diagnose and follow patients with other forms of intra- and extraspinal pathology.

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