A 56-year-old woman presented with chronic back pain.


Figures A (sagittal T1) and B (sagittal T2) show low-lying conus medullaris and a small intradural lipoma (at the level of L3-L4) as well as a sacral meningeal cyst.

Figure C (axial T2) shows a syringomyelia (at the level of L2), and Figure D (axial T2) shows diastematomyelia (at the level of L4). Figure E (axial T2) shows a thickened filum (at the level of L4-L5) as well as a sacral meningeal cyst, in Figure F.


Tethered cord syndrome


• Tethered cord syndrome is defined as a spectrum of congenital anomalies resulting in an abnormally low position of the conus medullaris that may lead to neurological, musculoskeletal, urological, or gastrointestinal abnormalities.

• Clinical presentation in adults includes lower extremity nondermatomal pain, often referred to the anorectal region; urinary and bowel movement disorders; spastic gait; and muscle atrophy. It may be subclinical until aggravated by factors that increase tension, such as trauma, disc herniation, or spinal canal stenosis.

• MRI is the modality of choice for diagnosis. The most common findings in adults are low-lying conus (below L2 vertebra) with intra- or extradural lipoma and a short, thickened filum terminale greater than 2 mm in diameter. Less common findings are split cord malformation and a dermal sinus. CT and plain X-rays are helpful for the evaluation of scoliosis in adolescents.

• Differential diagnosis are (not limited to) degenerative joint disease, spinal cord tumor, syringomyelia, and cord compression.

• Treatment mainly is surgical, especially when the patient presents with neurological deterioration.

— Pedram Parva, MD, is an attending radiologist at the Boston University School of Medicine and the VA Healthcare System in Boston as well as a radiology instructor at Harvard Medical School.

Figure A Figure B
Figure C Figure D
Figure E Figure F

  1. Hertzler DA Jr, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus. 2012;29(1):E1.
  2. Moriya J, Kakeda S, Korogi Y, Soejima Y, Urasaki E, Yokota A. An unusual case of split cord malformation. AJNR Am J Neuroradiol. 2006;27(7):1562-1564.
  3. Gupta SK, Khosla VK, Sharma BS, Mathuriya SN, Pathak A, Tewari MK. Tethered cord syndrome in adults. Surg Neurol. 1999;52(4):362-370.

Submission Instructions

  1. Cases should have clinical relevance and clear radiological findings.
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Submit cases via e-mail to Rahul V. Pawar, MD, at rvp325@gmail.com or to Radiology Today at jknaub@gvpub.com.

Section Editor: Rahul V. Pawar, MD, DABR
Department of Radiology, Division of Neuroradiology
Saint Barnabas Medical Center/Barnabas Ambulatory Care Center