Pediatric Radiology

, Volume 42, Issue 6, pp 685–691

Comparison of standard, prone and cine MRI in the evaluation of tethered cord

  • Sukhjinder Singh
  • Beth Kline-Fath
  • Karin Bierbrauer
  • Judy M. Racadio
  • Shelia Salisbury
  • Maurizio Macaluso
  • Elizabeth C. Jackson
  • John C. Egelhoff
Original Article



Tethered cord syndrome (TCS) is defined by abnormal traction on the spinal cord that confines its movement. Surgical cord release usually stops neurological deterioration; therefore, early and accurate neuroradiological diagnosis is important. Supine MRI is the imaging modality of choice, but prone MRI and cine MRI can demonstrate cord movement.


We compared the diagnostic accuracies of standard MRI, prone MRI and cine MRI in patients with clinical suspicion of TCS and evaluated inter-reader reliability for MR imaging.

Materials and methods

Children who underwent MRI for suspicion of TCS were retrospectively identified. Supine, prone and cine MRI studies were re-read by two pediatric neuroradiologists. Conus level, filum appearance and cord movement were documented.


Thirteen of 49 children had tethered cord documented at surgery. Conus level had the highest diagnostic accuracy (sensitivity 69–77%, specificity 94%, positive predictive value 82–83%, negative predictive value 89–92%, correct diagnosis 88–90%) and highest between-reader concordance (98%). Prone and cine MRI did not add to the accuracy of the supine imaging.


Conus level provides the highest diagnostic accuracy and inter-reader reliability in TCS. Until a larger series is evaluated, it remains questionable whether prone or cine MRI provides enough additional diagnostic information to warrant routine use.


Tethered cord syndrome MRI Prone MRI Cine MRI 


  1. 1.
    Warder DE (2001) Tethered cord syndrome and occult spinal dysraphism. Neurosurg Focus 10:e1PubMedCrossRefGoogle Scholar
  2. 2.
    Hertzler DA 2nd, DePowell JJ, Stevenson CB et al (2010) Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus 29:E1PubMedCrossRefGoogle Scholar
  3. 3.
    Witkamp TD, Vandertop WP, Beek FJ et al (2001) Medullary cone movement in subjects with a normal spinal cord and in patients with a tethered spinal cord. Radiology 220:208–212PubMedGoogle Scholar
  4. 4.
    Warder DE, Oakes WJ (1994) Tethered cord syndrome: the low-lying and normally positioned conus. Neurosurgery 34:597–600, discussion 600PubMedCrossRefGoogle Scholar
  5. 5.
    Koyanagi I, Iwasaki Y, Hida K et al (1997) Surgical treatment supposed natural history of the tethered cord with occult spinal dysraphism. Childs Nerv Syst 13:268–274PubMedCrossRefGoogle Scholar
  6. 6.
    Lew SM, Kothbauer KF (2007) Tethered cord syndrome: an updated review. Pediatr Neurosurg 43:236–248PubMedCrossRefGoogle Scholar
  7. 7.
    Steinbok P, Kariyattil R, MacNeily AE (2007) Comparison of section of filum terminale and non-neurosurgical management for urinary incontinence in patients with normal conus position and possible occult tethered cord syndrome. Neurosurgery 61:550–555, discussion 555–556PubMedCrossRefGoogle Scholar
  8. 8.
    Wehby M, O'Hollaren PS, Abtin K et al (2004) Occult tight filum terminale syndrome: results of surgical untethering. Pediatr Neurosurg 40:51–57PubMedCrossRefGoogle Scholar
  9. 9.
    Schenk JP, Herweh C, Gunther P et al (2006) Imaging of congenital anomalies and variations of the caudal spine and back in neonates and small infants. Eur J Radiol 58:3–14PubMedCrossRefGoogle Scholar
  10. 10.
    Rohrschneider WK, Forsting M, Darge K et al (1996) Diagnostic value of spinal US: comparative study with MR imaging in pediatric patients. Radiology 200:383–388PubMedGoogle Scholar
  11. 11.
    Gerscovich EO, Maslen L, Cronan MS et al (1999) Spinal sonography and magnetic resonance imaging in patients with repaired myelomeningocele: comparison of modalitits. J Ultrasound Med 18:655–664PubMedGoogle Scholar
  12. 12.
    Riccabona M, Sorantin E, Ring E (1998) Application of M-mode sonography to functional evaluation in pediatric patients. Eur Radiol 8:1457–1461PubMedCrossRefGoogle Scholar
  13. 13.
    Lam W, Victor A, Wong V et al (2004) Ultasound measurement of lumbosacral spine in children. Pediatr Neurol 30:115–121PubMedCrossRefGoogle Scholar
  14. 14.
    Selden NR, Nixon RR, Skoog SR et al (2006) Minimal tethered cord syndrome associated with thickening of the terminal filum. J Neurosurg 105(3 Suppl):214–218PubMedGoogle Scholar
  15. 15.
    Selden NR (2007) Minimal tethered cord syndrome: what's necessary to justify a new surgical indication? Neurosurg Focus 23:1–5CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Sukhjinder Singh
    • 1
  • Beth Kline-Fath
    • 2
  • Karin Bierbrauer
    • 4
  • Judy M. Racadio
    • 2
  • Shelia Salisbury
    • 5
  • Maurizio Macaluso
    • 5
  • Elizabeth C. Jackson
    • 6
  • John C. Egelhoff
    • 2
    • 3
  1. 1.Department of RadiologyCohen Children’s Medical CenterNew Hyde ParkUSA
  2. 2.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of RadiologyPhoenix Children’s HospitalPhoenixUSA
  4. 4.Department of NeurosurgeryCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  5. 5.Division of Biostatistics & EpidemiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  6. 6.Department of Pediatrics, Division of NephrologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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