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Tethered Cord

Last modified by Hussein Abdallah on 2025/05/27 03:15

 

FACTS

Punchline

Minor forms of dysraphism
- thickened and fatty filum terminale
- incidental bony spina bifida occulta 

CONSULT

HPI 

  • pregnancy history
  • developmental history 
  • gait changes 
  • urinary incontinence
  • night time accidents
  • UTI 
  • back pain
  • flank pain

FOCUSED EXAM

external stigmata of spinal dysrpahism 
- midline skin dimples over lumbar/sacral spine (not dimples over coccyx tip have no clinical significance) 
- midline spinal hemangiomata 
- midline atretic tails / skin tags
- superficial dermal sinus tracts
- bifid / Y-shaped gluteal fold 

walking (toe walking) 

IMG 

MRI L-spine without contrast
- find the tip of the spinal cord on T2 (the conus) 
- evaluate neural elements on T1 
- fatty filum terminatle will be T1 HIGH, T2 LOW 

A/P

Pre-op work-up

[ ] MRI pan neuro-axis since associated with Chiari 1 (2%) and a syrinx (small but important minority patients)

[ ] +/- urodynamic testing 

- Greenberg: "Urinary dysfunction improves in more than half, but not all patients, after surgical correction"

OR

[ ] Filum transection. Consider doing Chiari surgery before tethetered cord (either same surgery or separate) 
[ ] Laminectomy vs. laminoplasty, stay medical to facets and no concerns about instrumentation 

Post-op

[ ]Monitor for urinary retention/constipation (generally transient)
[ ] flat 1-2 days (pseudo/leak prevention) 

[ ] keep foley 

Notes

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Figure 1