Radiographic and clinical outcome of syringomyelia in patients treated for tethered cord syndrome without other significant imaging abnormalities

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The surgical management of patients with symptoms of tethered cord syndrome (TCS) who lack significant radiographic abnormalities is controversial. One potential MRI marker for TCS is a spinal cord syrinx or syringomyelia. Alternatively, a syrinx may be a benign and incidental finding. In this report the authors evaluated a highly selected cohort of patients with symptoms of TCS with minimal radiographic abnormalities other than syringomyelia. They analyzed clinical and radiographic outcomes after tethered cord release (TCR).


A retrospective review of data from 16 children who met the study inclusion criteria was performed. All patients had been surgically treated at Riley Hospital for Children in Indianapolis, Indiana, between 2006 and 2011. All children had clinical symptoms of TCS as well as available pre- and postoperative MRI data.


The most common presentation (12 [75%] of 16 patients) was urinary dysfunction, defined as symptoms of urgency or incontinence with abnormal urodynamic studies. Clinical follow-up data were available in 11 of these 12 patients. All 11 had improvement in symptoms at an average follow-up of 17 months. Seven (87.5%) of 8 patients presenting with back or leg pain had improvement. Three patients had progressive scoliosis; 2 had stabilization of the curve or mild improvement, and 1 patient had worsening deformity.

Radiographic follow-up data were obtained an average of 14.5 months after surgery. Twelve patients (75%) had stable syringomyelia after TCR. Four patients showed improvement, with 2 having complete radiographic resolution.


Highly selected patients with symptoms of TCS did very well clinically. Patients with abnormal urodynamic studies, pain, and gait disturbances showed a high rate of symptomatic improvement. However, a smaller percentage of patients had radiographic improvement of the syrinx. Therefore, the authors suggest that the decision to perform TCR should be based on clinical symptoms in this population. Symptomatic improvement was not necessarily related to radiographic resolution of the syrinx.

Abbreviations used in this paper:TCR = tethered cord release (surgery); TCS = tethered cord syndrome.

Article Information

Address correspondence to: Daniel H. Fulkerson, M.D., Indiana University School of Medicine, Goodman Campbell Brain and Spine, Riley Hospital for Children, 702 Barnhill Drive, #1134, Indianapolis, Indiana 46202-5200. email:

Please include this information when citing this paper: published online December 21, 2012; DOI: 10.3171/2012.11.PEDS12251.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Representative images of an unchanged rostral syrinx. Left: Preoperative sagittal T2-weighted MR image obtained in a 3-year-old boy, showing a syrinx extending to the cervical region. Right: Sagittal T2-weighted MR image obtained 1 year after surgery, demonstrating an unchanged syrinx, although the patient improved clinically.

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    Representative images of an improved caudal syrinx. Preoperative sagittal (A) and axial (B) T2-weighted MR images obtained in a 22-month-old girl, showing a syrinx in the caudal spinal cord. Postoperative sagittal (C) and axial (D) T2-weighted MR images obtained 1 year after surgery, demonstrating near-complete resolution of the syrinx.



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