gms | German Medical Science

Objective: Tethering of the spinal cord rarely occurs in the cervical region and the presentation in adulthood is extremely rare. Here, we report the case of a 30-year old female with a progressive symptomatic cervical tethered cord presenting with paresthesia and episodic spasmodic pain of the left arm. In patients with a tethered cord conventional MR imaging frequently fails to detect stretched-induced pathological changes of the myelon despite the presence of spinal cord dysfunction.

Methods: As recent developments in neuroimaging suggest that diffusion tensor MR imaging (DTI) may be more sensitive to detect spinal cord injuries we included DTI in our pre- and postoperative work up.

Results: Neuroradiological evaluation of the spine revealed a dorsal extension of the myelon at level C2/3 which merged into a restiform structure stretching out to the nuchal skin. Changes in diffusion tensor MR imaging parameters allowed the visualization of tethering-induced abnormalities of the myelon. We performed a microsurgical intradural detethering of the myelon and excised a firm, string-like structure consisting of fibrous connective tissue with a chronic inflammatory tissue response as assessed by histolopathologic analysis. Postoperatively the patient reported an immediate relief of symptoms with no recurrence during the follow up period. DTI-MR imaging one year after surgery demonstrated a clearly normalized cranial-caudal fiber orientation at the detethered level.

Conclusions: Spinal dysfunction in our patient was clearly the result of tethering of the cervical cord by a histologically regressed congenital dermal sinus tract. Conventional MR imaging revealed no pathological intramedullary signal changes which could explain the progressive neurology. In contrast, DTI revealed abnormal parameters at the level of tethering. This case demonstrates that DTI in patients with a tethered cord is feasible and has the potential to add valuable information.