Patient's question:
Professor Li, hello. My child is now one year old. When they were born, we noticed a 1x1.5 cm abnormality and indentation about 3 cm below the buttocks. At that time, the doctor recommended checking with the spinal surgery department. When the child was two and a half months old, we had an MRI at Shandong Provincial Hospital. The imaging findings are as follows: The lumbar spine sequence is regular, with partial non-fusion of the L5-S3 vertebral arches. The spinal canal is widened below L4, with an irregular tubular long T1 short T2 abnormal signal seen subcutaneously at L5 and S1, appearing as high signal on FS-T2WI, suggesting communication with the spinal canal. The conus medullaris morphology is normal, reaching the lower margin of L4, and the cauda equina nerve root pathway is well.Imaging diagnosis results: 1. Consistent with low spinal cord MRI findings, recommend follow-up observation. 2. Partial non-fusion of L5-S3 vertebral arches is consistent with MRI findings of sacral dysraphism. 3. The subcutaneous abnormal signal at L5 and S1 appears to communicate with the spinal canal, recommend follow-up observation.
Doctor's answer:
MR imaging shows typical imaging of terminal spinal cord tethering: The spinal cord is tethered at the level of S1, stretched straight without normal physiological curvature, and the distal end loses its normal pencil-point shape, appearing like a ribbon tail. Since there are currently no symptoms, the significance of surgery is greater, as it can preserve more normal spinal cord function. The purpose of the surgery is to prevent the occurrence or further worsening of nerve damage. Currently and in the foreseeable future, dead neurons and torn nerve fibers cannot regenerate. After spinal cord damage, if spinal and nerve damage symptoms (incontinence of urine and feces, lower limb and pelvic floor dysfunction, and deformities, essentially chronic and progressive paralysis) occur, the existing damage cannot be reversed. Moreover, based on current imaging, such as pelvic floor and lower limb electromyography, urodynamic, and anorectal manometry tests, subclinical damage may already exist. Therefore, it is recommended to undergo surgery as early as possible. Otherwise, there is also a possibility of sudden paralysis due to certain (such as a sudden braking while driving or bending over to lift a heavy object).