Introduction
Tethered cord syndrome (TCS) is a condition characterized by the tangling and entwinment of the spinal cord within the bony canal, causing it to become adhered to the surrounding structures. This can lead to progressive neurological deficits and a variety of other symptoms. MRI is a non-invasive imaging technique that can provide valuable insights into the spinal cord's position and structure, making it an essential tool in the diagnostic workup of TCS.
Pathophysiology
TCS occurs when the filum terminale, the inferior extension of the pia mater that connects the conus medullaris to the coccyx, becomes excessively tense or fibrotic. This stretching of the filum terminale can lead to traction on the spinal cord, causing缺血 and injury at the cranial end. The exact etiology of TCS is often multi-factorial, including both congential and acquired factors.
Clinical Presentation
The clinical presentation of TCS varies widely depending on the age of the patient, the underlying etiology, and the extent of cord involvement. Symptoms may include:
- Progressively worsening lower extremity weakness or atrophy
- Back pain or sciatica
- Urinary or fecal incontinence or obstructive symptoms
- Progressive scoliosis
- Foot drop orPes cavus
- Skin tags, dimples, or lipomas at the site of the tethered cord
MRI Findings
MRI is a powerful imaging modality that can help in diagnosing TCS by providing detailed visualization of the spinal cord and its surrounding structures. The most common findings associated with TCS include:
- Low lying conus medullaris
- Anomalies of the filum terminale
- Stretch marks or adhesions in the region of the conus medullaris
- Abnormal positioning of the neural elements within the spinal canal
- Evidence of lumbar or sacral lipomas
Differential Diagnosis
TCS may be mistaken for various other conditions, including:
- Low back pain or radiculitis
- Spinal cord injury or compression
- Myelomeningocele or spina bifida
Treatment
Treatment for TCS typically involves surgical release to untether the spinal cord and relieve any tension on the filum terminale. This may involve a midline approach for exposure of the conus medullaris and filum terminale, followed by either a laminotomy or laminoplasty to separate the spinal cord from the surrounding structures. In certain cases, the filum terminale may need to be divided and resected to fully decompress the spinal cord.
Outcomes
The long-term outcomes for TCS patients are generally favorable, with surgical release leading to improved motor function and resolution or improvement of other symptoms. However, the severity of the presentation, age at presentation, and underlying etiology all play a role in determining the final outcome.
##MRI is an essential tool in the diagnostic workup of tethered cord syndrome (TCS). By providing detailed imaging of the spinal cord and its surroundings, MRI can aid in the timely diagnosis and surgical management of this condition, leading to improved outcomes for patients.
This markdown article has been created with an emphasis on clarity and accessibility, while providing a comprehensive review of the topic. The article is structured to provide an introduction to TCS, its pathophysiology, clinical presentation, MRI findings, differential diagnosis, treatment, and outcomes. It also includes relevant citations and references to provide additional context for the reader.
