When Good Is Not Good Enough

Importance of Physical Examination and Imaging in the Detection of Tethered Cord Syndrome

“…The initial presentation of TCS may be neurological dysfunction. 16 It is essential to monitor urinary function to evaluate for new-onset urinary incontinence, changes in voiding patterns, or recurrent urinary tract infections. 9 Early detection of worsening urological function permits timely tethered cord release prior to irreversible urological damage.…”

“…1,2,4,10,11 Lesions with a high index for suspicion include hypertrichosis (a silky “hairy patch”), lipomas, dermoid cysts or dermal sinuses, and 2 or more cutaneous lesions. 2,4,7,16,18 Hypertrichosis is commonly observed with other cutaneous manifestations of OSD, which may be indicative of an underlying spinal defect, and intraspinal lipomas are often associated with a tethered cord. 4…”

“…Any dimple lying superior to the gluteal cleft, outside the midline, and with a diameter greater than 5 mm commonly accompanies a spinal anomaly and warrants radiological investigation such as an MRI. 4,16,18,19 A simple sacral dimple is located in the midline, within the gluteal cleft, has a diameter less than 5 mm, and is less than 2.5 cm from the anus. 10,18,20 Simple isolated sacral dimples, more properly called coccygeal pits, are usually not associated with OSD; therefore, spinal imaging is often not recommended.…”

“…A spinal US is a simple, inexpensive, and noninvasive screening tool for detecting OSD in infants less than 3 months of age when the vertebrae have not completely ossified. 2,4,7,10-12,16,22 A neonatal US has a 50% to 70% sensitivity in detecting any OSD. 4,22 However, the use of LsCMs as a screening tool for OSD results in many more false positives than true positives.…”