gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Congenital cervical tethered cord in an adult – utility of spinal diffusion tensor MR imaging

Meeting Abstract

  • Nils Ole Schmidt - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Deutschland
  • Frank Raimund - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Deutschland
  • Ann-Freya Foerster - Klinik und Poliklinik für Radiologie, Universitäts-Krankenhaus Eppendorf, Deutschland
  • Jens Fiehler - Klinik und Poliklinik für Radiologie, Universitäts-Krankenhaus Eppendorf, Deutschland
  • Dietrich Winkler - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Deutschland
  • Manfred Westphal - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1811

DOI: 10.3205/10dgnc282, URN: urn:nbn:de:0183-10dgnc2823

Published: September 16, 2010

© 2010 Schmidt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

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.