Determination of Fetal Spinal Cord Measurement for Every Gestation Age

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.

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

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/9/7/062 ◽

2008 ◽

Vol 9 (1) ◽

pp. 62-66 ◽

Cited By ~ 15

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.

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

Tethered Cord Syndrome in Children and Adults ◽

10.1055/b-0034-80515 ◽

2010 ◽

Keyword(s):

Spinal Cord ◽

Conus Medullaris ◽

Tethered Spinal Cord ◽

Normal Position

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Anatomy of the Spinal Cord

10.1093/med/9780197512166.003.0007 ◽

2021 ◽

pp. 60-67

Author(s):

Jennifer A. Tracy

Keyword(s):

Spinal Cord ◽

Vertebral Body ◽

Spinal Canal ◽

Conus Medullaris ◽

Lower Limbs ◽

Cervical Cord ◽

Filum Terminale ◽

Upper Limbs ◽

Descending Pathways ◽

Lumbar Vertebral Body

The spinal cord begins as the cervical cord immediately below the medulla and extends through the spinal canal, where it becomes the thoracic, lumbar, sacral, and coccygeal parts of the cord. In most persons, the spinal cord proper ends at the lower portion of the first lumbar vertebral body, where it forms the conus medullaris and, finally, the filum terminale. A cervical enlargement contains the innervation pathways of the upper limbs; a lumbar enlargement contains the pathways of the lower limbs. This chapter reviews ascending and descending pathways in the spinal cord.

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Walking with Neuropathic Pain: Paradoxical Shift from Burden to Support?

Case Reports in Medicine ◽

10.1155/2015/764950 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 7

Author(s):

David J. Kopsky ◽

Jan M. Keppel Hesselink ◽

Roberto Casale

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Unusual Case ◽

Body Schema ◽

The Body ◽

Sensory Loss ◽

Pain Patient ◽

Rehabilitation Programs ◽

Cord Injury

Baclofen 5% cream can be used for the treatment of neuropathic pain. We describe an unusual case of a neuropathic pain patient with spinal cord injury. A 71-year-old woman with a partial spinal cord injury lesion at L4 complained of tingling, pins and needles, and burning in her legs. She scored her pain as 6 before adding baclofen 5% cream to her pain medication (pregabalin 450 mg, acetaminophen 3000 mg, and diclofenac 150 mg daily). One month later she experienced complete pain relief, though experienced increased difficulties in walking, leading to frequent falls. Her steadier walking without stumbling and falling was more important to her than pain reduction. Thus she decided to stop using baclofen. This unusual case report discusses two important issues that relate to pain medicine and rehabilitation in patients with painful spinal cord lesions: (1) the presence of wide areas of sensory loss “covered” by the presence of painful sensations and (2) pathological sensations that can be used and integrated in the body schema to create an improved spatiovisual orientation and thus mobility. Both these aspects have to be taken into account when treating pain and design rehabilitation programs.

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Intramedullary Spinal Capillary Hemangioma: Case Report

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0035-1570100 ◽

2015 ◽

Vol 36 (02) ◽

pp. 125-127

Author(s):

Leonardo Welling ◽

Mariana Welling ◽

Eberval Figueiredo

Keyword(s):

Spinal Cord ◽

Complete Removal ◽

Conus Medullaris ◽

Capillary Hemangioma ◽

The Body ◽

Accurate Information ◽

Histopathological Diagnosis ◽

Intramedullary Lesion ◽

History Of

AbstractCapillary hemangiomas involving the neuraxis are very uncommon. In the spinal cord, they are located mainly intradural and extramedullary. To our knowledge, only four cases in conus medullaris have been previously described. In our case, a 46-year-old man was admitted with back pain, sphincter disturbances, as well as progressive weakness and numbness on the lower extremities. Magnetic resonance imaging revealed an undefined intramedullary lesion on the conus medullaris. The patient underwent microsurgery, which achieved complete removal. Histopathological diagnosis was compatible with capillary hemangioma. His postoperative course was uneventful and all symptoms, including bladder dysfunction clearly regressed. The treatment of intramedullary capillary hemangiomas is very critical in preventing unnecessary morbidity, providing accurate information with respect to prognosis, and establishes a regular outpatient follow-up. The natural history of this lesion involving the spinal cord is not well described, although they are common elsewhere in the body.

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Intradural migration of bullet in vertebra corpus after meningitis

Romanian Neurosurgery ◽

10.33962/roneuro-2020-097 ◽

2020 ◽

pp. 570-573

Author(s):

Halil İbrahim Gündüz ◽

Turan Kandemir

Keyword(s):

Spinal Cord ◽

Male Patient ◽

Spinal Canal ◽

The Body ◽

Gunshot Injury ◽

Diagnosis And Treatment ◽

Thoracic Region ◽

Neural Damage ◽

Over Time

In a gunshot injury, the spinal cord of the thoracic region is usually the most affected and damaged part of the body. In most cases, the bullet cannot be removed without causing more damage to the injury. Over time, the bullet tends to travel in different areas of the body. Moreover, cases on bullet movements in the spinal canal were reported in the literature. In this study, we reviewed the diagnosis and treatment of a 27-year-old male patient with a bullet detected in his vertebra corpus, which is caused by a gunshot injury. During the follow-up period, an intradural migration of the bullet from the vertebra corpus was observed. Furthermore, we performed surgery to prevent any future neural damage. In this study, we focused on a case with a gunshot injury, presenting an intradural migration of a bullet from the vertebra corpus after meningitis.

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The Origin of the Interoceptive Pathway

How Do You Feel? ◽

10.23943/princeton/9780691156767.003.0003 ◽

2014 ◽

Author(s):

A. D. (Bud) Craig

Keyword(s):

Spinal Cord ◽

Motor Function ◽

Contralateral Side ◽

Dorsal Column ◽

The Body ◽

Sensory Loss ◽

Anatomical Basis ◽

Touch Sensation ◽

Temperature Sensations ◽

The Brain

This chapter describes the functional and anatomical characteristics of interoceptive processing at the levels of the primary sensory fiber and the spinal cord. The association of the spinothalamic pathway with pain and temperature had already been described in textbooks for years. The clinical evidence indicated that a knife cut that severed the spinal cord on one side produced a loss of pain and temperature sensations only on the opposite (contralateral) side of the body, as tested with pinprick and a cold brass rod, combined with the loss of discriminative touch sensation and skeletal motor function on the same (ipsilateral) side as the injury to the spinal cord. The anatomical basis for this dissociated pattern of sensory loss is the distinctness of the two ascending somatosensory pathways to the brain-discriminative touch sensation in the uncrossed (ipsilateral) dorsal column pathway, and pain and temperature sensations in the crossed (contralateral) spinothalamic pathway.

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Postural deficiency in children with spinal stenosis

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors6413-19 ◽

2018 ◽

Vol 6 (4) ◽

pp. 13-19

Author(s):

Igor E. Nikityuk ◽

Elizaveta L. Kononova ◽

Sergei V. Vissarionov

Keyword(s):

Spinal Cord ◽

Regression Analysis ◽

Spinal Stenosis ◽

Thoracic Spine ◽

Postural Balance ◽

Spinal Canal ◽

The Body ◽

Congenital Deformity ◽

Healthy Children ◽

Mean Power

Introduction. Stenosis of the spinal canal can be accompanied by abnormalities of gait and body balance. At the same time, changes occurring in the postural control in children with spinal stenosis remain unexplored. Aim. To study postural stability in children with spinal stenosis and assess the imbalance of the body depending on the level of stenosis localization. Material and methods. This study investigated 14 patients, aged 10–17 years, with stenosis of the spinal canal. The first group consisted of seven patients with spinal stenosis due to congenital deformity of the thoracic spine with spinal cord compression at the stenosis level. The second group consisted of seven patients with spondylolisthesis of the L5 vertebra body of grades 3–4, accompanied with spinal cord root compression. The control group consisted of seven healthy children of the same age. We used stabilometry, and statistical study included correlation-regression analysis. Results. A significant deviation of the stabilometric parameters was noted only in the first group of patients (p < 0.05). In the same group, a strong correlation was found between the parameters of statokinesiogram: area S, length L, amplitude A, and mean power level of the spectrum of f 60%, which were much higher than those of healthy children, which may indicate a pathologically high synchronization of the vertical balance control system of the body. Other changes were revealed, such as a strong relationship between L/S and A at normal stabilometric parameters and a moderate force between L/A and f 60%, indicating postural deficiency in the group of patients with stenosis at the level of the lumbosacral spine. Correlation-regression analysis for assessing the postural balance in both groups of patients showed a correlation between parameters L, S, A, and f 60%, which were significantly higher than those in healthy children and most pronounced in the thoracic localization of stenosis. Conclusion. The system of maintaining vertical balance of the body in children with stenosis of the spinal canal at the level of the thoracic spine has a more pronounced deficiency than that in patients with stenosis of the canal at the lumbosacral level. To reveal hidden violations of the postural balance, the relationship between length, area, amplitude, and mean power of the statokinesiogram must be evaluated.

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Tethered Cord Syndrome

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.4.42536 ◽

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.

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