Tethered Cord

Definition

 

Conus medullaris below L2 / tethered

- unable to move freely with movement / growth

 

Aetiology

 

Thickened filum terminale (> 2mm at L5/S1)

Intradural lipoma

Diastomatomyelia

 

Surgery to close myelomeningocoele

- almost all will have signs of tethered cord at site of surgery

 

Issue

 

Stretches and damages the cord as child grows

- neurology

- pain

- difficulty walking

- foot deformity

 

Rapid progression of scoliosis

 

Clinical

 

80 - 90% of children will have cutaneous manifestation

 

MRI

 

Management

 

Open surgical release

 

Indication

- child

- neurological symptoms

- progressive scoliosis