Tethered cord syndrome and transitional vertebrae

Surg Radiol Anat. 2020 Feb;42(2):111-119. doi: 10.1007/s00276-019-02341-5. Epub 2019 Sep 19.


Purpose: Tethered cord syndrome (TCS) usually presents with low-lying conus medullaris and thickened filum terminale. Spinal cord anomalies usually accompany congenital malformations and variations of the vertebral column. Transitional vertebrae (TV) are common variant, especially in the lumbosacral region. Accurate definition of the spine level is essential for proper radiological diagnosis and treatment. In this study, congenital spinal cord and vertebral anomalies and the relation with TV groups and types were evaluated in TCS patients.

Methods: The study was performed in 97 patients. Radiological imaging findings [computed tomography (CT), magnetic resonance imaging (MRI), and radiography] and medical records were evaluated. Spine bony malformation, spinal cord malformation, and spinal level of malformation were compared with TV and non-TV groups in TCS patients. In addition, TV groups and types were compared with each other for these anomalies.

Results: There was no statistically significant difference between TV and non-TV group in terms of the presence of vertebral bone and spinal cord anomalies. There were some significant differences in some of the spine bone and spinal cord anomalies among the groups and types of TV.

Conclusion: Sixty-two point nine percent TCS patients had TV. Although these findings indicate that TV is common in patients with TCS, no significant difference is observed in most of the studied anomalies. However, there were some differences among the TV groups and TV types in relation to congenital malformations. It can be concluded that TV anomaly could be a distinct malformation apart from all the other anomalies that were studied. Transitional vertebrae may cause pain due to biomechanical changes in addition to progressive neurological symptoms which are usually seen with TCS.

Keywords: Lumbosacral transitional vertebrae; Spinal cord; Tethered cord syndrome; Thoracolumbar junction; Transitional vertebrae.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anatomic Variation*
  • Cauda Equina / abnormalities*
  • Cauda Equina / diagnostic imaging
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Lumbar Vertebrae / abnormalities*
  • Lumbar Vertebrae / diagnostic imaging
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neural Tube Defects / complications*
  • Neural Tube Defects / diagnostic imaging
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Young Adult