Neurologic recovery with conservative management in symptomatic tethered cord

Abstract

Background We present a case of a male adolescent with Spina Bifida who had new gait difficulty and fatigue following a fall. On physical exam, he had new right quadriceps weakness and progression of his hip flexion contractures. Initial studies included radiographs of his lumbar spine and pelvis, which revealed no acute bony injury or a significant change of his chronic bilateral dislocated hips. Magnetic resonance imaging (MRI) of the brain, cervical spine, and lumbar spine were obtained. MRI of the brain and cervical spine showed no definitive etiology. MRI of the lumbar spine showed a small syrinx from T9 to the conus and changes suggestive of a tethered cord. Neurosurgical evaluation concluded with a diagnosis of symptomatic tethered cord and surgical release was recommended. However, the patient was hesitant to undergo surgery. On follow-up exam, he had new bilateral hip adductor weakness increasing right quadriceps weakness. Further studies included electrophysiologic testing which showed severe ongoing denervation in the right L2–L4 innervated muscles and an MRI of bilateral thighs, which did not show any abnormalities of the adductor or quadriceps muscles. While the MRI of the lumbar spine did show a low lying conus with thickened filum terminale, it did not show other significant spinal or disc abnormalities to correlate with the electrophysiologic results. He was initiated on a physical therapy program. Materials and methods This is a case presentation with a chart and literature review.