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.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Further Reading
Ackerman LL, Menezes AH (2003) Spinal congenital dermal sinuses: a 30-year experience. Pediatrics 112:641–647
International Society of Paediatric Neurosurgery Guide: https://www.ispn.guide/. A freely available online educational resource providing up to date and evidence based information on all paediatric neurosurgical conditions. Compiled by internationally renowned clinicians
Yamada S, Iacono RP, Andrade T, Mandybur G, Yamada BS (1995) Pathophysiology of tethered cord syndrome. Neurosurg Clin N Am 6:311–323
References
Ackerman LL, Menezes AH (2003) Spinal congenital dermal sinuses: a 30-year experience. Pediatrics 112(3 Pt 1):641–647
Asil K, Yaldiz M (2018) Conus medullaris levels on ultrasonography in term newborns: normal levels and dermatological findings. J Korean Neurosurg Soc 61(6):731–736
Bademci G, Saygun M, Batay F, Cakmak A, Basar H, Anbarci H et al (2006) Prevalence of primary tethered cord syndrome associated with occult spinal dysraphism in primary school children in Turkey. Pediatr Neurosurg 42(1):4–13
Barkovich AJ, Edwards MS, Cogen PH (1991) MR evaluation of spinal dermal sinus tracts in children. Am J Neuroradiol 12(1):123
Cools MJ, Al-Holou WN, Stetler WR, Wilson TJ, Muraszko KM, Ibrahim M et al (2014) Filum terminale lipomas: imaging prevalence, natural history, and conus position. J Neurosurg Pediatr 13(5):559
DiPietro MA (1993) The conus medullaris: normal US findings throughout childhood. Radiology 188(1):149–153
Emami-Naeini P, Mahdavi A, Ahmadi H, Baradaran N, Nejat F (2008) Brain abscess as a manifestation of spinal dermal sinus. Ther Clin Risk Manag 4:1143–1147
Fitzgerald K (2011) Ultrasound examination of the neonatal spine. Australas J Ultrasound Med 14:39–41
Foster MT, Moxon CA, Weir E, Sinha A (2019) Dermal sinus tracts. BMJ 366:l5202
Garceau GJ (1953) The filum terminale syndrome (the cord-traction syndrome). J Bone Joint Surg Am 35-a(3):711–716
Gupta DK, Shastank RR, Mahapatra AK (2005) An unusual presentation of lumbosacral dermal sinus with CSF leak and meningitis. Pediatr Neurosurg 41(2):98–101
Hall WA, Albright AL, Brunberg JA (1988) Diagnosis of tethered cords by magnetic resonance imaging. Surg Neurol 30(1):60–64
Hertzler DA 2nd, DePowell JJ, Stevenson CB, Mangano FT (2010) Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus 29(1):E1
Hoffman HJ, Hendrick EB, Humphreys RP (1976) The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Childs Brain 2(3):145–155
Jindal A, Mahapatra AK (2001) Spinal congenital dermal sinus: an experience of 23 cases over 7 years. Neurol India 49(3):243–246
Kesler H, Dias MS, Kalapos P (2007) Termination of the normal conus medullaris in children: a whole-spine magnetic resonance imaging study. Neurosurg Focus 23(2):E7
Kumar J, Afsal M, Garg A (2017) Imaging spectrum of spinal dysraphism on magnetic resonance: A pictorial review. World J Radiol 9(4):178–190
Lane J, Dias M, Iantosca M, Zacharia T, Tubbs RS, Rizk E (2017) Dermal sinus tract of lumbosacral spine in children: patterns on magnetic resonance imaging and scoring system. Cureus 9(12)
Mehta DV (2017) Magnetic resonance imaging in paediatric spinal dysraphism with comparative usefulness of various magnetic resonance sequences. J Clin Diagn Res 11(8):TC17–TC22
Radmanesh F, Nejat F, El Khashab M (2010) Dermal sinus tract of the spine. Childs Nerv Syst 26(3):349–357
Raghavendra BN, Epstein FJ, Pinto RS, Subramanyam BR, Greenberg J, Mitnick JS (1983) The tethered spinal cord: diagnosis by high-resolution real-time ultrasound. Radiology 149(1):123–128
Reimann AF, Anson BJ (1944) Vertebral level of termination of the spinal cord with report of a case of sacral cord. Anat Rec 88(1):127–138
Schneider S, Rosenthal A, Greenberg B, Danto J (1993) A preliminary report on the use of laser-Doppler flowmetry during tethered spinal cord release. Neurosurgery 32:214–218
Singh I, Rohilla S, Kumar P, Sharma S (2015) Spinal dorsal dermal sinus tract: An experience of 21 cases. Surg Neurol Int 6:S429–S434
Stamates MM, Frim DM, Yang CW, Katzman GL, Ali S (2018) Magnetic resonance imaging in the prone position and the diagnosis of tethered spinal cord. J Neurosurg Pediatr 21(1):4–10
Stetler WR Jr, Park P, Sullivan S (2010) Pathophysiology of adult tethered cord syndrome: review of the literature. Neurosurg Focus 29(1):E2
Unsinn KM, Geley T, Freund MC, Gassner I (2000) US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics 20(4):923–938
Vassilyadi M, Tataryn Z, Merziotis M (2012) Retethering in children after sectioning of the filum terminale. Pediatr Neurosurg 48(6):335–341
Warder DE (2001) Tethered cord syndrome and occult spinal dysraphism. Neurosurg Focus 10(1):e1
Warder DE, Oakes WJ (1993) Tethered cord syndrome and the conus in a normal position. Neurosurgery 33(3):374–378
Yamada S, Won DJ, Pezeshkpour G, Yamada BS, Yamada SM, Siddiqi J et al (2007) Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg Focus 23(2):E6
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Sunderland, G., Ellenbogen, J. (2023). Dermal Sinus Tract and Tethered Cord Syndrome. In: Puri, P., Höllwarth, M.E. (eds) Pediatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-81488-5_41
Download citation
DOI: https://doi.org/10.1007/978-3-030-81488-5_41
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-81487-8
Online ISBN: 978-3-030-81488-5
eBook Packages: MedicineMedicine (R0)