Robert Glenn Hayter MD, Presenter: Nothing to Disclose

Neil W. Tishkoff MD, Abstract Co-Author: Nothing to Disclose

Felix Lee Lin MD, MPH, Abstract Co-Author: Nothing to Disclose

Judith Gorelick MD, Abstract Co-Author: Nothing to Disclose

The purpose of this report is to describe a unique encounter involving a case of adult tethered cord with diastematomyelia.

A 53 year-old woman with history of chronic pain, parathesias, and a neurogenic bladder requiring catheterization was referred to our hospital for definitive care. Initial workup involved MDCT using a Siemens Sensation 64 and MRI using a Siemens Trio 3.0T. The patient then underwent an L4/S1 laminectomy for spinal cord untethering and section of the filum terminale with intra-operative neurophysiologic monitoring. Intra-operative pictures were obtained to document the surgical findings. Post-procedure MRI was performed to confirm the intra-operative findings.

Initial CT imaging demonstrated posterior sacral dysraphism with partial sacral/coccyx agenesis. Initial MRI demonstrated adult tethered cord syndrome with type II sacral agenesis and fatty infiltration of the filum terminale. Lumbosacral diastematomyelia (type 2) beginning at the L5 level was noted. Intra-operative findings included two thickened hemifilum. The duplicated filum was examined with neurophysiologic monitoring, confirmed to lack any significant neural activity (the left hemifilum had minimal sensory function and no motor function, the right hemifilum had no sensory or motor function), and then sectioned. Immediately upon sectioning of the duplicated filum, the rostral stumps ascended in the spinal canal by 1-2 cm and the caudal stumps descended in the spinal canal by 1-2 cm with a separation between the cut ends. Neurophysiologic monitoring was confirmed to be at preoperative baseline. Post-procedure MRI demonstrated a 2.5 cm gap separating both aspects of the tethered cord at L5/S1, consistent with prior sectioning. Internal type II lumbosacral diastematomyelia was confirmed at the L5 level with a post sectional component at the S1 level extending inferiorly to a dysraphic S3 level.

Based on the findings this report describes the first known case of both post section retraction of an adult tethered cord and of lumbosacral diastematomyelia beginning at the L5 level extending inferiorly to a dysraphic S3 level involving one neurally active hemicord and one fibrous hemifilum.

This report describes the first known case of both post section retraction of an adult tethered cord and of lumbosacral diastematomyelia beginning at the L5 level extending to the S3 level.

Hayter, R, Tishkoff, N, Lin, F, Gorelick, J, Adult Tethered Cord with Distematomeylia: A Case Report of Cord Retraction Immediately after Sectioning and Lumbosacral Diastematomyelia.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11006267.html