Wolfgang Hirsch (Leipzig)  

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15 Years  

Male  

Spinal canal / Myelon  

neoplastic  

15 year-old boy, for 6 months increasing waddling gait. Urinary incontinence recently began. Suggestion of pes cavus on both sides.  

A tethered cord syndrome develops from a fixation of the mostly thickened filum terminale at the sacrum. In dysraphy (myelomeningocele), there is (almost) always a TC. Very often there are lipomas in or around the filum (inclusion tumors).

The harm usually occurs through the years by slowly ischemic alterations of the conus medullaris, which is particularly harmed through bending motions. Also, the often-called conus low-level is not always to be seen initially. A normal conus level does not therefore necessarily rule out a TC.  

<- view MRI 1

MRI 1: T1-weighted sag: high signal tumor below the conus medullaris, which is at the level of the 2nd lumbar vertebra. This could be fat or Meth-Hb.













<- view MRI 2

MRI 2: T2 weighted without fat saturation: high signal tumor, which fills the spinal canal at the level of the 3rd lumbar vertebra. This could be fat or fluid. Within the conus medullaris there is a widened syrinx/hydromyely seen.













<- view MRI 3

MRI 3: T2-weighted with fat saturation: the signal in the filum tumor-inclusion disappears, and the hydromyely remains. Therefore it is surely a tumor with fatty contents.












<- view MRI 4

MRI 4: T1-weighted before contrast media: The signal of the tumor has disappeared.












<- view MRI 5

MRI 5: T1-weighted after contrast media: A contrast media uptake is not seen.












<- view MRI 6

MRI 6: Subtraction images before and after contrast media: A contrast media uptake is not seen.









 

Total constellation (Consens)  

Teratoma, in this MRI-constellation no others.  

Surgery to relieve the cauda is necessary.  

N/A  

N/A  

N/A  

tethered cord, filum, lipoma, inclusion TM, tethered spinal cord, dysraphy, thickened filum terminale, waddling gait, urinary incontinence, myelomeningocele, filum terminale lipoma, filum terminale, conus terminale, conus terminale lipoma, child, childhood, pediatric radiology  

Wolfgang Hirsch. Tethered spinal cord with filum terminale lipoma. PedRad [serial online] vol 3, no. 2.
URL: www.PedRad.info/?search=20030206170902