Features of positional magnetic resonance imaging in tethered cord syndrome.
OBJECTIVE
Tethered cord syndrome (TCS) is a clinical entity in which symptoms are induced through excessive tension on the spinal cord. The radiological method of choice to confirm TCS is magnetic resonance imaging (MRI), however limitations exist especially in patients with no underlying spinal dysraphism.


METHODS
The positional MRI features of TCS in a series of four patients with suspected or proven TCS are described, especially with respect to contact of the myelon or the cauda equina with the dorsal elements of the lumbar spinal canal. The findings are correlated with the lordosis angle of the lumbar spine.


RESULTS
In flexion contact of the myelon or the cauda equina with the dorsal elements of the lumbar spinal canal is reduced due to a straightening of the lumbar spine. With increasing lordosis of the lumbar spine, the degree of contact increases and detection of TCS is more difficult. The site of tethering could be identified in all four patients in flexion.


CONCLUSIONS
Positional MRI can be useful to confirm or rule out TCS and helpful to identify the site of tethering. The value of positional MRI is limited to patients who are able to fully flex the lumbar spine and in patients without spinal canal stenosis and spondylolisthesis.
Praxis für Upright MRT Köln Rodenkirchen, Maternusstr. 44, 50996, Cologne, Germany. p.niggemann@mrt-koeln.de
P
P
Niggemann
S
S
Sarikaya-Seiwert
H K
HK
Beyer
R
R
Sobottke
D000293:Adolescent; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009436:Neural Tube Defects / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000002:abnormalities* / Q000473:pathology*
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