Presentation
Progressive symmetric sensory loss and slight motor impairment in the lower extremities.
Patient Data
Low-lying conus medullaris - it ends at the level of the L3 vertebra.
Taut, slightly distally thickened and fatty (see T1-weighted sagittal sequence) filum terminale, which is positioned dorsally. In the lumbar region it lies in contact with the posterior dura mater.
Widened spinal canal (dural ectasia) at the level of sacral bone, where also an incomplete closure of S2 vertebral arch (spina bifida occulta) is visible (note the fatty gap on sagittal T2-weighted images).
No major degenerative changes of the lumbar spine, which could explain the aforementioned symptoms.
Case Discussion
Usually tethered spinal cord is a diagnosis made in childhood, as the spinal canal may grow slower than the spinal column and cause significant neurological impairment. Sometimes it goes undiagnosed until adulthood, as in this case.
It may be a case of tight filum terminale syndrome, but a surgical and histological confirmation would be needed for the definitive diagnosis.
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