There may be skin tags on the sacrum, forming a tail

Introduction The abnormal skin of the lumbosacral region is the clinical manifestation of the tethered cord syndrome. Individual infants may have skin fistulas and form tails. Tethered cord syndrome (TCS) is a syndrome in which a spinal cord or a cone is pulled due to various congenital and acquired causes, resulting in a series of neurological dysfunctions and malformations. Because the spinal cord is pulled more often in the lumbosacral medulla, causing the cone to be abnormally low, it is also called the lower spinal cord. Tethered cord syndrome is more common in newborns and children, and is rare in adults, with more women than men.

Cause

1. Various congenital spinal dysplasia

Such as meningocele, spinal cord fissure, spinal meningocele, etc. due to insufficiency of the end of the neural tube. Most of the cases after birth were repaired within a few days. The purpose was to repair the abnormal nerve tissue as normal as possible. It is important to prevent cerebrospinal fluid leakage, but after the spinal dural tube is rebuilt. The adhesion produced during the healing process causes tethering at the end of the spinal cord.

2. Spinal cord lipoma and dural and extrahepatic lipoma

It is caused by the premature separation of the neuroectodermal and epidermal ectoderm, and the adipocytes of the mesodermal leaves enter the neuroectodermal leaves that are not yet blocked. Adipose tissue can enter the center of the spinal cord, or it can be connected to the subcutaneous fat tissue through a separate vertebral arch to fix the conus of the spinal cord. Moreover, the cases after the early childhood are related to the inflammation of the fat existing in the subarachnoid space, resulting in fibrosis around the nerve roots and adhesions caused by tethering.

3. Latent sinus

It is the neuroectodermal and epidermal ectoderm that are not well differentiated, and the locally formed cord-like tissue from the skin through the subcutaneous, spinal, causing tethering to the spinal cone. It can also be proliferated by the tissue of the latent sinus wall to produce dermoid cysts and epidermoid cysts and teratomas, which can surround or pull the spinal nerves and cause tethering.

4. Spinal cord longitudinal fissure

The mechanism of the occurrence of longitudinal fissures of the spinal cord is thought to be caused by abnormalities other than the nerves, that is, the developmental abnormalities of the vertebrae. It is also considered to be an abnormal occurrence of the nerves, and subsequent abnormalities of the development of the vertebrae. The spinal cord is separated from the left and right, with a dural tube with both split and non-dividing types. That is, type I: double dura capsule double spinal cord type, that is, the spinal cord is in the longitudinal fissure, completely separated by fibers, cartilage or osteophytes, divided into two, each with its dura mater and arachnoid, spinal cord partition Pulling, causing symptoms. Type II: the common spinal capsule double spinal cord type, the meninges in the longitudinal fissure, separated by fiber septum, 2 parts, but there is a common dura mater and arachnoid, generally no clinical symptoms.

5. The end of tension

It is due to the process of degeneration of the terminal end of the spinal cord, which is degenerate to form a terminal filament, which causes the terminal filament to be thicker than the normal terminal filament, and the remaining part causes the tethered cord.

6. Neurogenic intestinal cyst

The so-called neurogenic intestinal cyst is a state in which the mesenteric margin of the intestine and the tissue in front of the spine form a traffic due to the patent of the notch of the spinal cord. According to the degree of patent ductus arteriosus and communication, there may be manifestations of bone defects associated with the anterior spine, called the intestinal fistula and the intestinal cyst inside and outside the spinal canal.

7. Postoperative complications such as lumbosacral sulcus

Some scholars estimate that this can account for 10% to 20% of all surgical cases.

an examination

Related inspection

X-ray examination of bladder mammography

1.MRI

It is the best and preferred method of diagnosis for tethered cord syndrome. It can not only find the low spinal conus, but also clearly cause the cause of tethered cord syndrome.

2. CT angiography

CT myelography can show the relationship between lipoma, spinal cone, cauda equina and dura mater, which can guide the development of surgical approach. In addition, CT can show skeletal deformities, spina bifida, intraspinal tumors, and the like. However, the sensitivity and reliability of CT diagnosis of tethered cord syndrome are not as good as MRI. CT vertebral angiography is also an invasive examination. Therefore, for patients with typical tethered cord syndrome, MRI diagnosis is sufficient. Because MRI and CT have their own advantages and disadvantages, MRI and CT angiography should be combined with the diagnosis of complex tethered cord syndrome or MRI.

3. X-ray film

Because MRI and CT angiography have become the main diagnostic methods of this disease, X-ray plain film and conventional spinal canal angiography have been rarely used. X-ray plain film examination is only used to understand the presence of scoliosis and preoperative vertebral body positioning.

4. Neurophysiological examination

It can be used as a means to diagnose tethered cord syndrome and to judge the recovery of postoperative neurological function. Hanson et al. measured the electrophysiological manifestations of tendon reflexes in patients with tethered cord syndrome and found that the shortening of the sacral reflex latency is one of the electrophysiological features of tethered cord syndrome. Boor measured SSEPs in the posterior tibial nerve in patients with secondary tethered cord syndrome and found that SSEPs were decreased or negative. After reoperation, the SSEPs of the posterior tibial nerve increased, confirming the recovery of neurological function after terminal silk release.

5.B Ultra

For patients <1 year old, because the posterior structure of the spinal canal is not fully mature and ossified, B-ultrasound can show the conus of the spinal cord, and it can be judged according to the pulsation of the spinal cord.

6. Bladder function test

Including intravesical pressure measurement, cystoscopy and urethral sphincter electromyography. Patients with tethered cord syndrome may have abnormalities such as sphincter-detrusor ataxia, elevated intravesical pressure (sputum) or decreased (hypotonic) and changes in bladder residual urine volume. Preoperative and postoperative bladder function tests are helpful to determine the curative effect.

Differential diagnosis

Tethered cord syndrome needs to be differentiated from lumbar disc herniation, lumbar muscle strain, myalgia, and spinal cord tumor. Adults also need to be differentiated from spinal stenosis. CT and MRI scans can help to confirm the diagnosis.

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