Dermal Sinus Tract and Tethered Cord Syndrome

Abstract

Dermal sinus tract is a congenital abnormality, which falls within the spinal dysraphism spectrum. Occurring as a result of focal incomplete disjunction during primary neurulation, it presents as a small and innocuous-appearing punctum in the dorsal midline (most frequently over the lumbar spine). The clinical course and complications are all but innocuous, however, as they are frequently associated with recurrent meningitis, spinal abscesses and epidermoid and dermoid inclusion tumours. Progressive and disabling neurological sequelae may occur as a result of delayed identification and management. Tethered cord syndrome is a condition associated with all spinal dysraphic conditions, wherein abnormal tension develops within the spinal cord. This is often as a result of tethering of the conus medullaris at a lower-than-normal position. Traction, resulting in ischaemia and hypoxia, leads to neural injury and a chronic and slowly progressive neurological syndrome, characterised by weakness, gait disturbances, sensory impairment and bladder/bowel dysfunction.