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(Top Left) Sagittal MRI T2-weighted image in a patient with a tethered cord; (Top Right) Sagittal MRI T2-weighted image in a normal; (Bottom Left) Axial T2-weighted image in a patient with a tethered cord; (Bottom Right) Axial T2-weighted image in a normal. Note on the axial images, the cauda equina is clearlly seen with the normal patient; where the spinal cord is present in the patient with a tethered cord, at the same level.
The spinal cord in adults normally terminates at the level of the L1 vertebral body. Tethered spinal cord syndrome can present with a slowly progressive myelopathy much like the syrinx. Often, symptomatic tethered cords present with an orthopaedic deformity. The orthopaedic abnormalities associated with the tethered cord can be varus, valgus, or cavus changes of the foot; recurrent dislocations of the hip; or rotational abnormalities of an extremity or extremities. An isolated presentation of scoliosis is not uncommon. Patients can occasionally present with progressive isolated gait abnormalities such as spastic or wide-based gaits. In addition to orthopaedic deformities, patients with tethered cords may present with spinal cord and or, less commonly, root dysfunction.
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