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Tethered Spinal Cords Follow-Up

A post-operative MRI scan is obtained in the hospital in most cases. Before the MRI era, it had been assumed that after "release" of a tethered spinal cord, there would be upward migration of the spinal cord. This, in fact, does not occur in most cases, and the conus remains in an abnormally low position. This is not problematic from a clinical perspective but is from a radiologic one inasmuch as a follow-up MRI done months or years later will invariably be reported as disclosing a "recurrent" tethered spinal cord. This is a misnomer inasmuch as this is a normal appearance and the post-operative MRI scan may only be interpreted in direct comparison with the pre-operative one. It is clear that the success of the surgery is based on the "release" of the base of the spinal cord from the adjacent tissues and the restoration of its mobility in response to alterations of posture. It is not necessary for there to be any rostral migration of the conus to assure satisfactory result. Finally, it is important to be aware that in the presence of a lipoma it is not necessary to remove all of the fatty tissue. It is the tether that is associated with neurological deterioration, and while the "bulk" of the lipoma may be removed, a small residual component is invariably present and is not associated with evolution of future symptoms.